Infective Endocarditis Flashcards
What is Infective Endocarditis?
formerly called bacterial endocarditis
infection of endocardium Inner layers of heart)
or
heart valves
In Infective Endocarditis what bacteria commonly causes it?
Streptococcus and Staphylococcus
The heart is resistant to?
Infection
Why is the heart resistant to infection?
Because endocardial surface and constant blood flow make it difficult for organisms to adhere to cardiac tissue.
What two factors are typically required for endocarditis to develop?
- abnormality of the endocardium
- microorganisms in the bloodstream.
Which bacteria that are commonly found on the skin and upper respiratory tract- are frequent causative agents (80%-90%)?
Staphylococcus aureus and streptococci
Bacteria that can also cause infective endocarditis that is commonly found in the mouth is called?
Streptococcus viridans
Bacteria that can also cause infective endocarditis that is commonly found in the GI tract is called?
Streptococcus enterococcus
Endocarditis can also arise when?
- sterile platelet form
fibrin thrombi form
(on the endocardium or heart valves)
In endocarditis where do sterile plate and fibrin thrombi form?
On the endocardium or heart valve
The pathogenesis of this condition (infective endocarditis) occurs in which three stages?
- bacteremia (bacteria enters the bloodstream)
- adhesion (Adherence to damaged endothelium attracting Platelet and thrombi)
- colonization (Proliferation )
In Infective endocarditis Proliferation of the organism along with inflammation leads to?
vegetation (including platelets, fibrin, microorganisms, inflammatory cells, and granulomatous tissue)
What happens in the process of Vegetation?
- platelets
- fibrin
- microorganisms
- inflammatory cells
- and granulomatous tissue
collect on the internal structures because of damage from the infection
In Infective endocarditis what happens with each heart contraction?
Some of this vegetation is dislodged and ejected from the heart. These small thrombi move throughout the body, collecting in the microcirculation and creating microhemorrhages (e.g., petechiae and hematuria). The thrombi can also travel to other locations, in which case they are known as embolisms, and become lodged there.
During Infective endocarditis thrombi form that travels, this is called?
embolism
When there is an embolism (thrombi that form and travel), what does it cause?
-Microemboli
and
- Microhemorrhage
(Petechiae and hematuria)
Infective Endocarditis causes which life-threatening complications?
- myocardial infarction (MI)
- stroke
- Seizures
- pulmonary embolism (PE)
(caused by the emboli traveling outside the heart)
What happens to the heart valves with Infective Endocarditis?
They can become scarred and perforated
If untreated, infective endocarditis is usually fatal, especially when?
It involves the valvular structures
In most cases infective endocarditis occurs in which side of the heart?
Left side of the heart
Which risk factors render patients more vulnerable to the development of infective endocarditis?
- IV drug use (vegetation of the right side of the heart, tricuspid valve)
- valvular disorder
- prosthetic heart valves
- implanted devices ((pacemaker, internal cardioverter)
- rheumatic heart disease
- aortic coarctation
- congenital heart defect (tetralogy of Fallot))
- Marfan syndrome
- Immunodeficiency states
- Hypertrophic cardiomyopathy
In infective endocarditis, when there is vegetation of the right side of the heart. which valve is affected?
Tricuspid valve
Clinical manifestations of infective endocarditis include?
- flulike symptoms (fever, chills, myalgia)
- embolization
- heart murmur
- petechiae
- splinter hemorrhages under nails
- hematuria
- Osler’s nodes
- edema
- genway lesions
- Roth spots
A clinical manifestation of infective endocarditis is embolization. Provide examples of embolization.
- myocardial infarction (MI)
- pulmonary embolism (PE)
- transient ischemic attacks
- stroke
- splenic infarction
A clinical manifestation of infective endocarditis is Osler’s node. What are Olser’s nodes?
tender raised subcutaneous lesions on the fingers and toes
A clinical manifestation of infective endocarditis is Genway lesions. What are Genway lesions?
small non-tender erythematous or hemorrhagic macular or nodular lesions on the palms or soles of the feet)
A clinical manifestation of infective endocarditis is Roth spots. What are Rothpots?
round hemorrhagic retinal lesions with small white centers (and conjunctival hemorrhages)
Diagnostic procedures for infective endocarditis include?
- history
- exam
- blood cultures and count
- urinalysis
- serum rheumatoid factor
- erythrocyte sedimentation rate (ESR)
- EKG or echocardiogram
- chest X-ray
What other treatments are initiated to maintain cardiac function and treat other symptoms?
(Infective endocarditis)
- Bed rest
- Oxygen therapy
- Antipyretics
- Surgical debridement or repair of cardiac valves
- Prosthetic valve replacement (fatal if untreated)
- causative agent-specific therapy
Antibiotic prophylaxis prior to certain dental procedures may be necessary in high-risk patients. Who are high-risk patients?
those with
- prosthetic cardiac valves
- congenital heart disease
With Infective endocarditis the common bacteria that affect the mitral valve is?
Staphylococcus aureus
What two valves are usually affected with Infective Endocarditis?
- Mitral valve
- Aortic Valve
What will can you see in an echocardiogram when someone has been affected with Infective Endocarditis?
- Aortic Stenosis
- moderate aortic insufficiency
- chronic valvular vegetation
- moderate atrial enlargement
With Infective endocarditis the common bacteria that affect the aortic valve?
- Streptococcus mutans
Application to Practice Case Study:
Acute endocarditis clinical manifestations are (signs and symptoms) (past 24 hours)?
- chills
- fever
- fatigue
- joint pain
- malaise
- headache
At admission, Mrs. Fulcher’s blood pressure was 172/48 mm Hg (supine) and 100/40 mm Hg (sitting), her pulse was 116, respirations were 20, and her temperature was 101.9°F. Additional assessment findings included a murmur; 2+ pitting tibial edema; no peripheral cyanosis; lung sounds clear bilaterally; orientation to person, place, and time but drowsiness; hematuria; and multiple petechiae on the skin of her arms, legs, and chest.
- hypotension, the wide pulse pressure, and tachycardia?
- What is the significance of the hematuria, joint pain, and petechiae?
- For which complications of embolization should Mrs. Fulcher be assessed?
