Clinician's Corner: Endocarditis
Summary
TLDRIn this educational video, Dr. Rishi, the Chief Medical Officer at All Samosas, discusses infective endocarditis, focusing on its signs and symptoms using the acronym FROM Jane. He covers diagnosis criteria like blood cultures and echocardiograms, emphasizing the importance of detecting subtle valve changes. Treatment typically involves antibiotics, with adjustments based on culture results. Dr. Rishi highlights the challenge of treating prosthetic valve infections, often requiring surgical intervention due to the biofilm nature of the infection, which necessitates prolonged antibiotic treatment.
Takeaways
- 🔍 In the script, the speaker, Rishi, introduces infective endocarditis and its signs and symptoms using the acronym FROM JANE.
- 🌡️ 'F' in FROM JANE stands for fevers, which is a common symptom of infective endocarditis.
- 👀 'R' stands for Roth spots, which are found during an eye exam and are indicative of the condition.
- 🎵 'O' represents Osler nodes, which are painful or tender, and are another sign of endocarditis.
- 💓 'M' is for murmur, specifically heart murmur, which is a key diagnostic sign of the disease.
- 👣 'Jane' in the acronym refers to Janeway lesions, which are non-painful and distinct from Osler nodes.
- 👁️ 'A' stands for nail bed or splinter hemorrhages, which can be seen as embolic phenomena on imaging studies.
- 🧬 Diagnosis of infective endocarditis involves Duke's criteria, with major criteria including blood cultures and echocardiograms.
- 🍯 Blood cultures are used to identify the causative organisms, often staphylococci or streptococci.
- 🛠 Echocardiograms are crucial for observing changes in valve movement, which may indicate the presence of endocarditis.
- 💊 Treatment typically involves long-term antibiotic therapy, with the choice of antibiotics depending on the culture results.
- 🔧 In cases of prosthetic valve endocarditis, surgical replacement may be necessary if antibiotic treatment fails, due to the difficulty of treating biofilm infections.
Q & A
What is the main topic discussed in the video script?
-The main topic discussed in the video script is infective endocarditis, focusing on its signs, symptoms, diagnosis, and treatment.
What is the acronym 'FROM JANE' used for in the context of endocarditis?
-The acronym 'FROM JANE' is used to remember the signs and symptoms of infective endocarditis: Fevers, Roth spots, Osler nodes, Murmurs, Janeway lesions, and Embolic phenomena.
What does 'Roth spots' refer to in the context of the acronym?
-Roth spots refer to small, flat, red spots on the retina that can be a sign of endocarditis.
What are 'Osler nodes' mentioned in the acronym?
-Osler nodes are small, painful, raised spots that can appear on the fingers, toes, or palms, and are associated with endocarditis.
What are 'Janeway lesions' and how do they differ from 'Osler nodes'?
-Janeway lesions are painless, red or purple spots on the palms and soles, distinct from Osler nodes which are painful and typically found on fingers and toes.
What is the significance of 'embolic phenomena' in the context of endocarditis?
-Embolic phenomena refer to the small blood clots that can break off from the infected valve and travel to other parts of the body, causing damage.
What are the major criteria for the diagnosis of infective endocarditis according to Duke's criteria?
-The major criteria for the diagnosis of infective endocarditis according to Duke's criteria include two positive blood cultures and an echocardiogram showing evidence of endocardial involvement.
What is the typical approach to treating infective endocarditis?
-The typical approach to treating infective endocarditis involves administering antibiotics, such as penicillin, gentamicin, or vancomycin, and potentially surgical intervention if the infection involves a prosthetic valve.
Why is the length of treatment for infective endocarditis often longer than other types of infections?
-The length of treatment for infective endocarditis is often longer because it is considered a biofilm infection, where antibiotics have difficulty penetrating the mucus layer to reach the bacteria, thus requiring a prolonged treatment period.
What is a clinical pearl mentioned in the script regarding the treatment of prosthetic valve endocarditis?
-The clinical pearl mentioned is that treating prosthetic valve endocarditis with antibiotics alone is often challenging due to the nature of the material, which may require surgical replacement of the valve.
What is the role of blood cultures in diagnosing infective endocarditis?
-Blood cultures play a crucial role in diagnosing infective endocarditis by identifying the causative organisms, such as Staphylococcus aureus or Streptococcus viridans, through large volume blood samples.
Outlines
🏥 Infective Endocarditis Overview
In this paragraph, Rishi, the Chief Medical Officer, introduces the topic of infective endocarditis, a serious heart condition. He discusses the signs and symptoms using the acronym 'CHAINS', which stands for fevers (F), Roth spots (R), Osler nodes (O), heart murmur (M), Janeway lesions (J), and nail bed or splinter hemorrhages (A). He also touches on the importance of blood cultures and echocardiograms in diagnosing the condition, emphasizing the subtle changes in valve movement that can indicate the presence of endocarditis. Additionally, he mentions the common organisms causing the infection, such as staph aureus or staph epi, and the challenges of treating prosthetic valves due to their plastic nature and the difficulty for antibiotics to penetrate.
🛠️ Treatment and Biofilm Infection Insights
The second paragraph delves into the treatment of infective endocarditis, highlighting the use of antibiotics like unison and gentamicin, or vancomycin with ciprofloxacin, especially in cases involving prosthetic valves. Rishi explains that the treatment duration is often lengthy, which is a clinical pearl he shares, due to the biofilm nature of the infection. Biofilms are described as a protective layer of mucus that makes it difficult for antibiotics to reach the bacteria, necessitating prolonged antibiotic therapy. This approach allows for the antibiotic concentration to eventually kill the bacteria over time. The paragraph concludes with a brief mention of Osmosis, an educational platform, inviting viewers to start a free trial.
Mindmap
Keywords
💡Infective Endocarditis
💡Acronym - FROM JANE
💡Roth Spots
💡Osler Nodes
💡Janeway Lesions
💡Echo
💡Blood Cultures
💡Antibiotics
💡Prosthetic Valve
💡Biofilm
💡Treatment Duration
Highlights
Introduction to Infective Endocarditis by Rishi, the Chief Medical Officer at All Samosas.
Discussion on signs and symptoms of Infective Endocarditis using the acronym CHAIN.
Explanation of the CHAIN acronym: Fevers (F), Roth spots (R), Osler nodes (O), Heart murmur (M), and Janeway lesions (A).
Clarification that Infective Endocarditis is not contagious.
Description of nail bed or splinter hemorrhages as evidence of embolic phenomenon.
Importance of Duke's criteria in the diagnosis of Infective Endocarditis.
Emphasis on blood cultures and echocardiograms as major diagnostic tools.
Common organisms causing Infective Endocarditis, such as Staphylococcus aureus and Streptococcus.
The subtle signs in echocardiograms that may indicate Infective Endocarditis.
Prosthetic valve dehiscence as a major criterion for the diagnosis of Infective Endocarditis.
Treatment of Infective Endocarditis typically involves long-term antibiotic therapy.
The challenge of treating prosthetic valve infections with antibiotics alone.
Surgical replacement as a necessary step in some cases of prosthetic valve infections.
Endocarditis as a biofilm infection and its implications for treatment duration.
The rationale behind the extended use of antibiotics in treating biofilm infections.
Conclusion summarizing the clinical aspects of Infective Endocarditis and its treatment.
Invitation to start a free trial at Osmosis for further learning.
Transcripts
all right how are you feeling today hey
guys I'm Rishi decide the chief medical
officer here at all samosas and I want
to talk a little bit about infective
endocarditis today so we're gonna talk
about a few different topics the first
one being signs and symptoms of
endocarditis specifically infective
endocarditis so there's an acronym a
handy acronym to kind of go through this
and it is from chain so just think maybe
you got in a car that is from Jane
although it's not contagious
so from Jane f stands for fevers from R
stands for Roth spots just think of the
eye exam o stands for Osler notes so I
think of ow
Osler al being because of painful or
tender M is murmur so heart murmur
Jane so Jay AME chain is Janeway lesions
and I think I'll just change weight
meaning oh just they're not painful
they're just Janeway lesions so they're
distinct from the also notes which are
al Osler a frenemy a-- and for nail bed
hemorrhages so I'm showing my nails but
nail bed or splinter hemorrhages are
sometimes called
an e fret embolize so sometimes you'll
see embolic phenomenon on CT scan or MRI
or something like that and that's often
evidence again of something cuts kind of
spewing off of your valve and kind of
seating other parts of your body so from
Jane are the signs and symptoms next
let's move down to diagnosis and for
diagnosis you really want to there's
Dukes pressure and many of the things
that I just went over our part of these
criteria specifically minor criteria but
for the major criteria the big things
you want to think about our two blood
cultures an echo so the blood cultures
basically get large volume blood
cultures you see if anything grows out
typically it's gonna be you know
something like staph aureus or staph epi
or Andrew Cox is dr. Cox IED so those
are the most common organisms there are
some very uncommon organisms
that are very uncommon but you should
kind of keep a lookout for yellow
being one of them that often kind of
people will mention because it's tested
using titers but anyway those are the
blood cultures so you see what the lot
grows out the other one being the echo
and the echo is actually kind of
interesting one from my perspective
because I always thought it would be a
vegetation on the valve that you're
looking at and that would be like Oh
endocarditis oftentimes it's something
that's much more subtle so it's like a
change in the way that the valve moves
maybe there's a new regurgitation or
sometimes it's literally just the way
it's moving is a little bit more stiffer
or it's not kind of moving as flexibly
as it was on a prior echo and sometimes
people at prior echoes if they've had
cardiac surgery or something so you can
kind of compare and contrast and say hey
is this valve looking the same as the
previous one so those are the kind of
two keys that you want to look at and
then if it's or if there's a prosthetic
valve dehiscence of the prosthesis is a
classic example of what an accord itis
will do so there's any evidence of
dehiscence then you want to make sure
that you would invest the effort and the
carditis
so those are the keys run diagnosis and
then treatment classically it's going to
be bacterial right so it's gonna be
impaired treatment with antibiotics and
specifically something like unison and
gent or you know if you're thinking
about vancomycin it might be Bank gent
and cipro or sometimes where Fantin is
added on especially around prosthetic
valves so it's gonna be some combination
of those antibiotics and usually this is
just for a few days until you actually
get a culture back and once you see the
culture and the susceptibilities you can
say okay let's just change the
antibiotic regimen accordingly that's
all well and good the key though is the
length of treatment and I say the key
because sometimes you have to treat for
a long time and with prosthetic valves
in particular it's something to do 3 for
a long time it still won't work and
you'll have to get a surgical
replacement done and so just keep in
mind that with prostheses I often think
of prosthesis is being kind of like
plastic in a way and antibiotics don't
treat plastic very well as you can
imagine plastic doesn't blood vessels
phantom products can't get to plastic so
if there's a infection of any prosthetic
material
it's very hard to treat with antibiotics
alone so usually end up having to take
out that valve and and surgically
replacing it so anytime there's
prosthetist it prostheses antibiotics
are usually going to be tried at first
and oftentimes it fails and then you
have to just surgically replace so
that's the keys on treatment and then
one clinical pearl on one I kind of
leave you with is just thinking about
endocarditis as being a biofilm
infection so you think about biofilms is
being bacteria and then there's stuff in
this mucus right so essentially what
happens is antibiotics have a hard time
getting through that mucus to get down
to this bacteria that may be at the
bottom so the key there is just a length
of treatment you end up giving
antibiotics for weeks and weeks as
opposed to let's say a UTI or something
where you give it for maybe three days
or five days with a biofilm infection
usually giving antibiotics for a long
period of time because the way that we
essentially try to counter the fact that
defuses what we're kind of waiting on is
we just let it last for a long time and
over time the concentration of
antibiotic one of the bacteria gets high
enough to where the bacteria will die so
that's why the length of treatment for
endocarditis is so long now is kind of
wondered about that is essentially
because the biofilm infection is what
we're dealing with so anyway I will
leave you with that and I hope that
helped you understand some clinical
aspects of infective endocarditis
Thanks five bye bye start your free
trial today at osmosis org
you
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