内科学教学课件：Infective Endocarditis (IE).pptVIP

ECG: occasionally find MI or AV block intraventricular block UCG: find out excrescence, if excrescence ≥10mm, it is easy to cause artery embolism, UCG can also find previous heart disease and complications in the heart. UCG show excrescence Diagnosis standard Major criteria Positive blood culture Typical organism from two cultures Persistent positive blood cultures taken 12 hours apart Three or more positive cultures taken over more than 1 hour Endocardial involvement Positive echocardiographic findings of vegetations New valvular regurgitation Minor criteria Predisposing valvular or cardiac abnormality Intravenous drug misuse Pyrexia =38℃ Embolic phenomenon Vasculitic phenomenon Blood cultures suggestive-organism grown but not achieving major criteria Suggestive echocardiographic findings Definite endocarditis: two major, or one major and three minor, or five minor Possible endocarditis: one major and one minor, or three minor treat Antibiotics principles early stage, soon after 3～5 cultures Enough dose and period of treatment IV, keep high and stable blood drug concentration If pathogen is uncertain, For acute cases: Staph. Aurous, gram-negative bacilli. For subacute cases: streptococcus. drug sensitivity test should be done if positive culture appear. minimum inhibitory concentration (MIC), Susceptible (S), Intermediate (I) Resistant (R) E.g.: Penicillin S: MIC0.1μg/ml I: 0.1μg/mlMIC1.0μg/ml R: MIC≥1.0μg/ml staphylococcus aurous oxacillin Cefazolin Vancomycin streptococcus viridians penicillin，1.2mu～1.8mu/d，4～6 weeks, plus amikacin. if allergic to penicillin, choose ceftriaxone Fungi: amphotericin b or fluconazole If drug can not treat IE satisfactorily, surgical operation is needed. The prognosis is disapointed. Infective Endocarditis (IE) generalization infective endocarditis is formed by microbic excrescence on inner layer of the heart, the endocardium. The most common structures involved are the heart valves, defective septum, chordae tendine