Infectious Endocarditis Flashcards
Infective Endocarditis
Infection of the inner surface of the heart, usually the valves. Characterized by inflammation of the endocardium caused by infectious agents.
Subacute bacterial endocarditis
A form of endocarditis, a type ofendocarditis(more specifically,infective endocarditis). Subacutebacterial endocarditiscan be considered a form of type III hypersensitivity.
Signs and Symptoms of Infective Endocarditis
Insidious onset within two weeks (in 85% of cases) of precipitating event with organisms of low pathogenicity (viridans group streptococci)
Symptoms of endocarditiscan range from mild to severe and may vary depending on the type of bacteria causing the infection and whether you have had heart problems in the past. Signs of endocarditis can include: Fever Chills Fatigue Muscle or joint aches Headaches Night sweats Shortness of breathand chest pain Swelling in feet, legs, or abdomen
Emboli/immunologic response may produce: stroke, MI, blindness, abdominal pain, petechiae, Osler nodes, splinter hemorrhages, Janeway lesions.
Other, less common symptoms of endocarditisinclude:
Unexplained weight loss
Blood in the urine
Red spots on the soles of your feet or palms of your hand
Red, tender spots under the skin of your fingers and toes
Tiny purple or red spots in the whites of your eyes or inside your mouth
Tenderness in the spleen
Causes of Infective Endocarditis
The cause is due to when a bacteria enters the blood stream and attaches to the lining of the heart or valves. * commonly we are able to fight off the bacteria. However, certain bacteria that live in the mouth, throat, skin and gut can sometimes cause serious infectionslike endocarditis.
Pathogens of Infective Endocarditis
Pathogens of IE:
Anatomic/physiologic predisposition (endothelial damage)
Non-bacterial thrombotic endocarditis(NBTE)
Bacteremia (source??)
Bacterial colonization of vegetation
Additional deposition and growth of thrombus
Embolization and bacteremia
Pathways for Germs
Daily oral hygiene- tooth brushing, flossing, which can cause the gums to bleed, and cause bacteria to enter the bloodstream.
Intravenous lines and catheters
An infection on or in your body, such as a skin sore, gum disease, or a sexually transmitted infection, may spread bacteria/fungi to your bloodstream.
Dental procedures; tooth extractions
Intravenous illegal drug use. Due to contaminated needles and syringes.
- Needles used for tattoos or piercings can allow bacteria to enter your
bloodstream and lead to endocarditis.
Who is endocarditis more likely to affect?
Endocarditis can happen in people with normal hearts, but it is more commonin people with heart abnormalities, including:
-Damaged heart valves
-Artificial heart valves
-Some types of congenital heart defects (heart abnormalities present at birth)
Implanted medical devices in the heart (such as a pacemaker)
Diagnostics to detect Endocarditis
Labs – will reveal anemia, Elevated WBC, ESR, CRP. Low RBC’s
Echocardiogram- to check for signs of infection.
Electrocardiogram- Can reveal if something is affecting the hearts activity.
Chest xray- Can reveal if the infection is causing the cardiac silhouette to enlarge secondary to the infectious process.
CT scan or MRI may be ordered if your provider feels that the infection has spread to the brain, or other parts of the body.
Duration of Infective Endocarditis
The duration of endocarditis can usually take quite some time. It can take several weeks before endocarditis subsides.
Once you undergo treatment, it takes several weeks to clear.
In more severe cases where damage is done to the heart valves, the effects of endocarditis can last for years. In some instances, surgery may be needed to correct the damaged heart valve.
Treatment of Infective Endocarditis
Antibiotics- IV
Cultures and sensitivities for appropriate verification of specific bacteria.
The patient will typically be hospitalized for a week and if they do well, will be discharged home on home IV antibiotics for 6 weeks.
If the endocarditis damages the valves, symptoms and complications may last for years. In some cases surgery is indicated and may necessitate valve repair, or replacement.
Prevention of Endocarditis/SBE prophylaxis
In the past, prophylactic (preventive)antibiotictreatments were given to almost everyone with a congenital heart defect one hour before dental procedures, oral surgery, or operations on the gut, genitals, or urinary tract.
Recommendations were changed in 2007 by the AHA
Now the highest risk people are treated with SBE before certain dental procedures.
Good dental hygiene is always recommended.
Complications of Infective Endocarditis
Endocarditis complications include:
Heart problems (heart murmur,heart failure, heart valve damage, abnormal heartbeat,heart attack)
Strokesor seizures
Pulmonary embolism (sudden blockage of blood flow to the lungs)
Pneumonia
Meningitisor other brain infections
Damage to kidneys or spleen
Endocarditis can cause clumps of blood cells and bacteria to form in the blood vessels of your heart. The clumps of cells are called vegetations. Vegetations, can break off and form blood clots. They can travel to other parts of your body where they can cause new infections or block blood flow.
It important to contact a provider immediately with any symptoms of endocarditis.
