Endocarditis Flashcards
What layer of the heart is the endocardium?
Innermost
What parts of the heart are affected by infective endocarditis?
Heart chambers or valves
Infective endocarditis is an infection of the heart chambers or valves
SUBACUTE endocarditis
Affects those with pre-existing valve disease and has a clinical course that can extend over months; MILDER in presentation; CHRONIC
ACUTE endocarditis
Affects healthy valves; manifests as a rapidly progressive illness; therapy must be prompt and vigorous
Two factors required to get endocarditis?
- A damaged epithelium (i.e., from valve replacements or defects)
- A port of entry (i.e., wound, dental procedure, IVDU)
Most common causative organisms of infective endocarditis
Staph aureus, strep viridans
Aside from bacteria, what other pathogens can cause infective endocarditis?
Fungi, viruses
When do clinical manifestations typically occur with endocarditis?
Typically occur within 2 weeks of bacteremia
Endocarditis clinical manifestations
Nonspecific
Low-grade fever (90% of patients), chills, weakness, malaise, fatigue, anorexia, arthralgias, myalgias, back pain, abdominal discomfort, weight loss, headache, clubbing of fingers (late manifestation)
What are vegetations?
The primary lesions of infective endocarditis. They consist of different cell pieces and microbes that stick to the valve surface. The loss of these fragile vegetations into the circulation results in emboli.
Where do left-sided vegetations move to?
Various organs (brain, kidneys, spleen) and extremities (causing limb infarction)
Where do right-sided vegetations move to?
Lungs (PE)
Two vascular manifestations of endocarditis
- Splinter hemorrhages
- Petechiae
Splinter hemorrhages
Black/reddish-brown longitudinal streaks in nail beds
Petechiae
From micro-embolization of vegetative valves. Can occur in conjunctivae, lips, buccal mucosa, ankles/feet, antecubital, popliteal areas, fingers
Three clinical manifestations that are uncommon but very suggestive of infective endocarditis
- Osler nodes
- Janeway lesions
- Roth spots
Osler nodes
Tender papulopustules on fingertips or toes
Janeway lesions
Flat/macular, painless, small red spots on palms and soles of feet
Roth spots
Hemorrhagic retinal lesions
Endocarditis clinical manifestations
New-onset murmur (85% of time)
HF (most common complication of infective endocarditis)
Endocarditis history and diagnostic tests
- History: recent (3-6 mo.) history of dental, urological, surgical, or gynecologic procedure; IVDA
- Positive blood cultures (3 blood cultures drawn over a period of 1 hour from 3 different sites will be positive in most patients with infective endocarditis)
- Echocardiogram (evidence of endocardial enlargement)
Who should be prophylactically treated for endocarditis?
Patients with a history of a prosthetic heart valve, infective endocarditis, congenital heart disease, or heart transplant
Under what situations should patients get prophylactic treatment for endocarditis?
- Oral-dental work
- Respiratory-respiratory tract incision (biopsy), tonsillectomy, adenoidectomy
- GI & GU-wound infection, UTI
Endocarditis drug therapy
Typically hospitalized initially and given IV antibiotics
Complete eradication may take weeks
Relapses are common
Endocarditis nursing care
Identify and educate high-risk individuals to avoid infections, have adequate rest periods, have good oral hygiene, and notify HCP before dental procedures.
Refer patients with IVDA for rehab
Endocarditis nursing care: home care
May include IV antibiotics
Have patient monitor for nonspecific s/s
