Endocarditis Flashcards
What layer of the heart is the endocardium?
Innermost, lining the chambers and valves.
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 _______ and has a clinical course that can extend over months; MILDER in presentation; CHRONIC
Affects those with pre-existing valve disease and has a clinical course that can extend over months; MILDER in presentation; CHRONIC
ACUTE endocarditis
Affects _________; manifests as a rapidly progressive illness; therapy must be prompt and vigorous
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 bacterial 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
specific (6)
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)
specific
- splinter hemorrhages – black/red/brown longitudinal streaks in nail bed
- petechiae – little bruises in conjunctiva, lips, buccal mucosa, ankles, feet, antecubital (elbows) and popliteal areas. d/t microembolization of vegetative valves (embolus in smaller vessels)
- osler nodes – tender papule and pustule lesions on finger tips and toes
- Janeway lesions – painless, flat/macular, small red spots on palms and soles of feet
- roth spots – hemorrhagic retinal lesions
- new onset murmur – murmurs are r/t opening/closing of valves so it makes since that with IE which involves damaged valves, there would be a murmur
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
Black/reddish-brown longitudinal streaks in nail beds
Splinter hemorrhages
Black/reddish-brown longitudinal streaks in nail beds
From micro-embolization of vegetative valves. Can occur in conjunctivae, lips, buccal mucosa, ankles/feet, antecubital, popliteal areas, fingers
Petechiae
From micro-embolization of vegetative valves. Can occur in conjunctivae, lips, buccal mucosa, ankles/feet, antecubital, popliteal areas, fingers