Infective endocarditis: links to our slides and good review articles

We recently had a nice review of non-bacterial thrombotic endocarditis.  The slides can be found (from UAMS on-campus computers) at this location: H:\IM Residents\Resident Presentations 2014-2015.  Looking back over these made me want to review bacterial endocarditis as well.

Here is a cool video of a bunch of heart surgeons at Mt. Sinai talking about whether or not to take patients to the OR.  Even though it's a little more depth than a general internist would be expected to have, the discussion is quite informative:



My favorite part of the video is the various academics making fun of each other and their ID colleagues.

I think the two best articles I've founda are this one from NEJM http://www.nejm.org/doi/full/10.1056/NEJMcp1206782 and the definitive IDSA and ACC guidelines in this pdf from Circulation http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/Endocarditis%20Management.pdf


 To sum up a few of the most commonly misunderstood and mismanaged areas:
 1) Echocardiogram should be ordered when Infective endocarditis is suspected (usually transthoracic first), but even more important is ordering the blood cultures.  Three sets of blood cultures should be ordered prior to abx.  TEE is much more sensitive thant TTE, but is only warranted in certain situations and usually only after the TTE.

2) Patients with infective endocarditis can go from stable on the floor to emergently destabilizing in a few hours.  An echocardiogram should be performed quickly and close attention must be paid to vital signs (widening pulse pressure or developing heart block may warrant quicker surgical intervention)

3) About half of patients will end up getting surgical valve replacement or repair.  Patients with refractory pulmonary edema or cardiogenic shock complicating their IE need emergent surgery within 24 hours.  The most appropriate timing of surgery is often difficult to be sure about, so having a multidisciplinary team with an ID specialits, a cardiologist, and a cardiothoracic surgeon involved early is wise.

Posted by Gank_90

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