Podcast 166 – Endocarditis with David Carr - a podcast by Scott D. Weingart, MD FCCM

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....

Further episodes of EMCrit Podcast

Further podcasts by Scott D. Weingart, MD FCCM

Website of Scott D. Weingart, MD FCCM