Endocarditis (Exam 1) Flashcards
Endocarditis
Inflammation / infection of the endocardium (inside the heart)
includes valves
Subacute Endocarditis
Affects those with pre-exiting valve disease and has a clinical course that may extend over months
milder in presentation
chronic condition
Acute Endocarditis
Affects healthy valves
Manifests as a rapidly progressive illness
Therapy needs to be prompt and rigorous
Endocarditis often results in
Valve Vegetations
Vegetations are commonly found using
Echocardiogram
Who get endocarditis? Need two things
Damaged epithelium
and
Port of entry (infection has to get into system) (endocardium)
Most common causative organism of IE
Bacterial
-s. aureus
-strep. varidans
(Does not have to be bacterial)
Endocarditis: Early Clinical Manifestations
Occurs within 2 weeks of a bacteremia
-low grade fever
-chills, weakness, malaise, fatigue, anorexia
-Arthralgias, myalgias, back pain, abdominal discomfort
-Clubbing of fingers
(non specific)
The loss of fragile vegetations result
systemic circulation and results in emboli
Left-sided vegetations travel to
-Brain
-Kidneys
-Spleen
-Extremities (limb infarction)
Right-sided vegetations travel to
Lungs (PE)
Pulmonary Embolism
Endocarditis: Vascular Manifestations
Splinter hemorrhages (common)
Petechiae (common)
Osler Nodes (uncommon)
Janeway Lesions (uncommon)
Roth Spots (uncommon)
Splinter hemorrhages
Streaks on nail bed from vegetations leaving left side of heart
Petechiae
Micro embolization of vegetative valves. Can occur in conjunctiva, lips, buccal mucosa, ankles/feet, antecubital, popliteal areas
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: Later Clinical Manifestations
New onset of murmur (valves are not opening and closing properly)
HF (most common complication)
What is the most common complication of IE
Heart Failure
Valves are not working and shutting properly
History that makes someone at risk for endocartitis
Recent (3-6 months)
Dental procedures
Urologic procedures
Surgical procedures
Gynecologic procedures
IVDA
Endocarditis: Diagnostic Test - Postive blood cultures
3 cultures drawn over 1 hour from 3 different sites = endocarditis
Endocarditis Diagnostic Test: Echo
Evidence of endocardial enlargement
If patient is at risk of endocarditis, should they get prophylactic treatment?
Yes they should get treatment before any procedure if they have:
-Prosthetic Heart Valve
-History of IE
-Congenital Heart Disease
-Heart Transplant
Endocarditis: Prophylactic Treatment before and during
Oral
-Dental work
Respiratory
-Resp tract incision
-Tonsillectomy and adenoidectomy
GI and GU
-Wound infection
-UTI
Care for Endocarditis: Drug Therapy
Typically IV and in hospital
Complete eradication may take weeks
Relapses common
Educate High Risk Individuals
Avoid infection
Adequate rest periods
Good oral hygiene
Notify HCP before dental and other procedures
Refer IVDA to rehab
Home care might include PICC line and monitor for non specific S/S
