Infective Endocarditis

Diagnosis and initial management

HAMED IBRHEM
BA 519
 Objectives
• Know the screening criteria (Duke’s criteria)
for endocarditis
• Know the initial work up of endocarditis
– Common exam findings
– Imaging modalities
– Lab work
 Predisposing factors to bacterial infective
endocarditis
1. Dental manipulation and disease
2. Instrumentation (urinary tract, GI tract, IV
infusions)
3. Cardiac surgery
4. Injection drug use
 (Modified) Duke’s Criteria
• Definitive IE (Clinical criteria)
– 2 major criteria OR 1 major and 3 minor criteria,
OR 5 minor criteria
• Possible IE
– 1 major and 1 minor, or 3 minor criteria
 Major Criteria
• Major
– Two Blood cultures positive with typical
organisms:
– Single positive blood culture for coxiella burnetti
– Echocardiogram positive for IE
 Minor Criteria
• Predisposition / predisposing heart condition,
• Fever, temperature >38C
• Vascular phenomena:
• Immunological phenomena:
• Microbiological evidence: + blood culture that
doesn’t meet major criteria
 Pretest Probability
• High risk patients (pretest probability > 4%):
– prosthetic valves
– congenital heart diseases
– previous endocarditis
– new murmur
– (new onset) heart failure
– Other stigmata of endocarditis (see next slide for
physical exam).
• Low Risk: EVERYONE ELSE!
Physical Exam findings
 Labs
• 3 sets of blood cultures from different sites
• CBC w/ diff: looking for leukocytosis, anemia
• evidence of kidney disease
• if kidney disease, evaluate for
hematuria/proteinuria
• EKG: look for conduction abnormalities
 Other Imaging
• If hypoxic, consider CXR
or CT of chest

• If focal neurologic deficits,

consider CT of head for
hemorrhagic stroke. MRI
if looking for ischemic
septic emboli.
 References
• Infective Endocarditis in Adults: Diagnosis,
Antimicrobial Therapy, and Management of
Complications, L. M. Baddour et al.,
Circulation. 2015
• Uptodate.com
• MKSAP17
• Medcomic.com