Thanks as always to YY for a great discussion. See below for some of the major learning from our case about endocarditis.
Take-home pearl: according to HH, approx. 25-30% of patients with left-sided endocarditis go on to require a valve replacement, even if there was no acute indication for a valve initially
Management of aortic regurgitation
- Valve surgery is the mainstay of treatment!
- Afterload reduction is a temporizing measure (if allowed by the blood pressure.) Nitroprusside is a good agent to use, but beware in patients with renal disease
- Balloon pumps are CONTRAINDICATED because inflation of the balloon in diastole will worsen the AR
What is Strep mitis?
- A type of viridans Strep
- Found in the oropharynx
- When thinking about viridans strep endocarditis, ask yourself two things
- Is it abscess forming? S. milleri, S. anginosus, S. intermedius
- Is it penicillin sensitive? This will affect your choice of therapy and whether it requires aminoglycoside synergy when treating