Some Points on Acute Endocarditis from the Talk

* Keep Endocarditis on the radar for all febrile patients without a source

* Examine your febrile-listen for murmur and look at teeth

* Ask about teeth cleaning in past 2 weeks

* Even though we were taught about Janeway lesions and Osler’s nodes in medical school, the reality is that these peripheral manifestations of endocarditis occur in only about 10% of patients.  Listening for heart murmurs which are present in about 90% of patients with endocarditis is one of the most important physical exam maneuvers in patients who present with fever

* Various Ways to Categorize

* Native Valve | Prosthetic Valve | IV Drug User

* Right vs. Left-sided

* Acute vs. Subacute

* Acute Endocarditis may present so acutely that a murmur has not yet developed despite the patient being quite ill

* Oh so fastidious, the HACEK organisms are Haemophilus species, Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae

* Endocarditis should be on your radar for any patient with valvular heart disease who presents to the ED whether they are febrile or not, especially if they are vaguely unwell

* Ideal cultures: 3 sets at 3 sites with an hour between first and last, each with a bunch of blood

* Coag-Negative Staph Aureus positive blood culture in a patient with valvular disease is endocarditis until proven otherwise, even though the majority of Coag Negative Staph Aureus positive blood cultures are contaminants. A blood culture positive for a particular type of Coag-Negative Staph Aureus called SLUG (Staphylococus lugdunensis) should raise the possibility of endocarditis even in patients without valvular heart disease

* Get nervous when the bacteria doesn't fit the crime

* No ED/ICU procedure requires prophylaxis

* 2/3 of L-sided emboli will be CNS. Brain emboli will be in the MCA territory

* Be scared of new-onset of CHF and CHF in young patients

* Look at the ECG for new heart blocks in patients with fever (Even 1st Degree HB) - Consider Valvular Abscess

* Antibiotic coverage-your empiric sepsis antibiotics + sepsis-dose Vanco will cover everything you need to worry about. Vanco alone will get the job done in almost every case

Indications for Operation

More Information

* Dave Carr on Anton Helman's Show

* Dave Carr from SMACC

* The AHA Guidelines (but highly recommend placing toothpicks under your eyelids before reading)

Now on to the Podcast....