Question

Tricuspid valve vegetations are the most likely abnormalities seen on echocardiogram. This patient has endocarditis affecting his tricuspid valve. Risk factors include injection drug use, male sex, age over 65 years old, and underlying structural heart disease. Diagnostic workup includes blood cultures and a transesophageal echocardiogram. A transesophageal echocardiogram has a higher sensitivity to detect vegetations than a transthoracic echocardiogram. Complications include sepsis and embolic events. In this case, the vegetations are on the right side of the heart and have embolized to the lungs causing a multifocal pneumonia (as shown above). Right-sided endocarditis is more common in intravenous drug users. Treatment includes intravenous antibiotic therapy (directed specifically against Staph. aureus) and supportive care.

What is the most common risk factor for right-sided endocarditis?
a) Female sex
b) Age under 30 years
c) Injection drug use
d) Regular exercise

Answer 1

The most common risk factor for right-sided endocarditis is injection drug use, due to the direct introduction of bacteria into the bloodstream. So, correct option is (c).

Step-by-step explanation:

The most common risk factor for right-sided endocarditis is injection drug use. Right-sided endocarditis often involves the tricuspid valve and is more frequently seen in individuals who inject drugs. This is due to the fact that injecting drugs can introduce bacteria directly into the bloodstream, which can then travel to the heart and cause an infection of the endocardium, the inner lining of the heart.

Use of unsterile needles or poor injection practices increases this risk significantly.

Diagnosis of endocarditis includes blood cultures to identify the causative organism and echocardiography to visualize any vegetations or abnormalities on the heart valves.

A transesophageal echocardiogram (TEE) has higher sensitivity when compared to a transthoracic echocardiogram (TTE) for detecting vegetations. Treatment typically involves intravenous antibiotics, targeting the specific bacteria involved, which in the case of injection drug users, is often Staphylococcus aureus.