Thread by @DrManiCardio

#FITSurvivalGuide #ACCFIT
#InfectiveEndocarditis.
1/10 Not comprehensive. ⬇️⬇️some imp. points. Hx, exam, echo, micro data essential to diagnose & treat apporpriately. Suggested read : 2014 ACC/AHA valve guideline with 2017 Focused update.

cc: @dr_chirumamilla

2/10
Incidence varies. Native IE 10-15/100K/year, PVE ~30% of all IE.

Risk ⬆️>60 years, ♂️sex, IV drug use, HIV, hemodialysis, poor 🦷 with infection, Alcoholic cirrhosis, intravascular device, CIED, immunosuppression, Transplants, Rheumatic ❤️ dz...

3/10
-Vegetations - "On the lower pressure side of a cardiac chamber / structural lesion or at site of impact of high-velocity blood jets "

-Acute vs Subacute IE
-Right vs Left sided IE
-Early (<60 days) vs Late ( >60days) Prosthetic IE

⭐️Modified Duke's criteria⭐️

4/10
Clinical features: "Great mimic of other chronic diseases"
Multiple symptoms 😷/signs. Attached image has most of the findings (Janeway lesion missing..)
Consequences: CHF, abscess, rupture of valve apparatus, systemic embolism, septic PE, mycotic aneurysms

5/10
-⭐️Blood cultures⭐️- Identification of 🦠, resistance pattern, surveillance..
-Difficult to culture 🦠, HACEK organisms, Culture negative IE...
-Pathology: Tissue culture - vegetatiosn, valves, hardware..

6/10
✔️ Echo
Vegetations, leaflet perforation, annular abscess, aneurysm, fistula, and prosthetic valve dehiscence, consequences of valve dysfunction including LV function, pulmonary HTN, Doppler of intracardiac flow abnormalities.

7/10
TTE vs TEE?🤔🤔
-Non-diagnostic TTE, Suspected complications, intracardiac leads - ✔️- TEE - Class I recommendation.

-When in doubt with high clinical suspicion, ✔️ TEE with consideration to clinical scenario, patient tolerability

8/10
Treatment : #EndocarditisTeam (Internists, Cardiologists, ID and CTS!!)
-❤️ Team discussions.
-💊💉Prolonged abx course, Surgery✂️✂️ , valve replacement, hardware removal
-Early vs Late ✂️?
-Focused update on Timing for ✂️for IE with stroke
-Central illustration

9/10
Last but not the least -- Not to forget IE prophylaxis!😀

10/10
Lots of resources available @ACCCardioEd @JACCJournals @UpToDate
Thanks to @dr_chirumamilla for this great idea, sending me the tips for Tweetorial (first one!) and coordinating this #FITSurvivalGuide !

Please add comments/points I missed.

@nsivcd @SanChris999 @Pooh_Velagapudi @chadialraies @DrSheilaSahni @bcostelloMD @majazayeri @Nidhi_Madan9 @fawazalenezi55 @GuruKowlgi @sabeedak1 @noshreza @SaggerMawri @KhandelwalMD @heartdoc45 @onco_cardiology @Regadenoson @SamRRazaMD @drvrvaidya @AnwarZaitoun @ZainAsadEP

@MusaSharkawi @iamritu @carolineaball @purviparwani
@AKassier @wohnsmd @RyanMadderMD @SangjinLee17 @DavidFerminMD @AndreGauri