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.