Infective Endocarditis

IE is an infection of native or prosthetic heart valves, endocardial surface or an indwelling cardiac device (such as a pacer or defibrillator). In recent years, we’re seeing it happen in older and more chronically ill patients. And more MRSA.

The diagnosis is tricky because the presentation can be fairly subtle. You need a high index of suspicion, fever and:

  • unclear infectious source
  • new regurgitant murmur
  • embolic events of unknown source

Get 3 sets of BCx in the ED before antibiotics and possibly a TTE. Patients should receive IV Abx and 1/2 of them require valve replacement or debridement surgery. Indications for surgery are:

  • development of heart failure
  • perivalvular abscess formation
  • uncontrolled infxn
  • Large, Mobile vegetations (that may flick off)


How to Take Smart Notes

In his book1, Sönke Ahrens describes two things to improve writing productivity:

  1. Routines for writing
  2. A system for organizing notes and ideas

He breaks down the daunting task of writing by pointing out:

  • Writing a book or manuscript would be easy if someone gave you the first draft.
  • Writing the first draft would be easy if someone gave you an organized set of ideas.
  • Generating the ideas would be easy if someone gave you a set of properly referenced notes from the literature.

Obviously, the “someone” in each of these scenarios is the same person. The routine comes from reversing the process, starting with taking a properly referenced set of notes – hence the title of the book.