ENDOCARDITIS
Osler’s
nodes, which are small reddish
tender areas on the
pulp of fingers or toes.
Janeway lesions are reddish
spots on fingers or toes,
but are painless.
A definite diagnosis of endocarditis (Duke's criteria) is achieved when 2 major criteria are present, or
1 major and 3 minor criterias.
Major criteria: blood culture
positive for typical organisms
persistent bacteremia
positive ECHO for
vegetations abscess or valve dehiscence
Minor criteria: valvular heart disease or IV drug user fever greater
than 38°C
vasculitis skin lesions
suggestive ECHO (but not definite)
positive blood culture
In a patient with prosthetic valve,
staph epidermidis (one of the
coagulase negative staph) and Strep
viridans are most common. Strep bovis,
and enterococcus are the
other organisms which commonly cause endocarditis.
One of the major dangers
with aortic valve endocarditis is an aortic
root abscess. This can lead to prolonging of the PR interval by erosion into the adjacent AV node,
hence daily ECGs are useful
for monitoring.
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