Delay in Diagnosis & Treatment of Endocarditis (Valvular Heart Disease)

Evaluate breaches in the standard of care in Delay in Diagnosis & Treatment of Endocarditis (Valvular Heart Disease)

Answer the following questions to find out if the standard of care was followed for your case.

  • Was a medical history obtained and documented?
    Yes
    No
    Why is this important?
    Infective endocarditis commonly occurs following invasive dental, gastrointestinal (GI), or genitourinary (GU) tract procedures.
    (2012) 56 EDECNA 1 235-244

  • With which of the following symptoms of endocarditis did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    The possibility of infective endocarditis must be considered in any patient who has had an unexplained fever for more than one week, especially if that patient has a known predisposition.
    (2003) 21 ECARDC 2 159-166

  • Which of the following risk factors were elicited from the patient’s medical history? (Choose all that apply) Why is this important?
    Answer this question
    Risk factors for endocarditis include degenerative, rheumatic, and congenital valve disease, invasive hospital procedures, prosthetic valves and intravenous drug usage (use of infected needles). It can also be triggered by common interventions such as dental procedures.
    (2009) 51 EPCARD 6 472-477

  • Was a thorough physical examination performed? Why is this important?
    Answer this question
    A physical examination is necessary to uncover cardiac and peripheral or cutaneous manifestations of infective endocarditis.
    Click here for additional information at ClinicalKey.com

  • Were blood cultures obtained? Why is this important?
    Answer this question
    Blood cultures are important in identifying the causative pathogen and also to guide antibiotic therapy.
    (2009) 51 EPCARD 6 472-477

  • Was an echocardiogram performed? Why is this important?
    Answer this question
    Echocardiography is essential for the diagnosis and management of infective endocarditis. It provides information about the presence and size of vegetation, the severity of regurgitant flow, complications such as abscess formation, and also myocardial function.
    (2009) 51 EPCARD 6 472-477

  • Which of the following laboratory studies and investigations were performed? (Choose all that apply) Why is this important?
    Answer this question
    The main diagnostic procedures for infective endocarditis are blood culture, echocardiography, and histologic analysis of any abnormalities in the routine laboratory study.
    (2012) 96 EMEDCN 6 1149-1169

  • Was endocarditis diagnosed? Why is this important?
    Answer this question
    The diagnosis of infective endocarditis is made by clinical history and examination, blood and tissue cultures, inflammatory markers, and echo-cardiography.
    (2009) 51 EPCARD 6 472-477

  • Was the patient referred to a specialist? Why is this important?
    Answer this question
    Once the diagnosis is suspected, referral to the appropriate professionals must be made in a timely manner. To deliver care requires a coordinated approach that allows sharing of skills and expertise. The skills of members from all professional disciplines must be utilized to enable all patients to receive directed treatment.
    Click here for additional information at ClinicalKey.com

  • Was the unstable patient started on antibiotics? Why is this important?
    Answer this question
    In patients who are severely ill or unstable and in whom immediate treatment is necessary, the need to cover methicillin-resistant staphylococci is necessary.
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  • With which of the following complications of endocarditis was the patient diagnosed? (Choose all that apply) Why is this important?
    Answer this question
    The most common complications of infective endocarditis is congestive heart failure. The most common embolic event is cerebral embolism. Renal dysfunction is another common complication caused by immune complex-mediated glomerulonephritis.
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  • Which of the following treatment options were initiated? Why is this important?
    Answer this question
    Prompt diagnosis and initiation of antibiotics is necessary, but many patients still require cardiac surgery.
    (2009) 51 EPCARD 6 472-477

  • Did the patient undergo surgery? Why is this important?
    Answer this question
    Once priorities have been established, referral to the appropriate professionals must be made in a timely manner. To deliver care requires a coordinated approach that allows sharing of skills and expertise. The skills of members from all professional disciplines must be utilized in order to provide precise care.
    Click here for additional information at ClinicalKey.com

  • Was the antibiotic regimen modified after obtaining the blood culture results? Why is this important?
    Answer this question
    Antibiotic treatment of infective endocarditis must be guided by susceptibility testing on the isolated pathogen. Quantitative susceptibility testing is required to determine the appropriate regimen.
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  • Was the patient monitored during treatment? Why is this important?
    Answer this question
    Patients must be monitored closely during the first two weeks of treatment, for evidence of a positive response to therapy and for the development of any untoward complications.
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  • How long was the antibiotic regime? Why is this important?
    Answer this question
    The objective is to administer antimicrobials for a sufficient length of time, usually 4-6 weeks, to eradicate the causative organism.
    (2009) 51 EPCARD 6 472-477

  • Was patient education provided? Why is this important?
    Answer this question
    The clinician must advise or inform at-risk patients and their caregivers of the following important points: • The signs and symptoms of infective endocarditis to look out for after a patient is discharged. • Indications of a reoccurrence. • The importance of dental check-ups, at least twice a year, to maintain good oral hygiene.
    Click here for additional information at ClinicalKey.com

  • Were follow-up evaluations advised? Why is this important?
    Answer this question
    Routine follow-up evaluations are necessary to offset any complications that may arise. Regular check-ups ensure that changes in the patient’s cardiac output and respiratory function are quickly assessed and remedied.
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  • How were the complications of endocarditis managed? Why is this important?
    Answer this question
    When endocarditis is suspected, urgent evaluation of the patient’s hemodynamic status is critical. If signs and symptoms of heart failure are present, an echocardiogram and several closely spaced blood cultures are obtained. antibiotic therapy and hemodynamic support must be provided without delay. Patients with heart failure often require urgent cardiac surgery.
    Click here for additional information at MD Consult.com