Infective Endocarditis Flashcards
Pericardium
External membrane (thin) that surrounds the heart
Two layers:
-Outer fibrous parietal layer
-Inner serous visceral layer
Has serous fluid which keeps friction down
Myocardium
Middle, muscular wall of the heart
Endocardium
Innermost tissue layer that lines the heart (endothelium)
Lines atria and ventricles
Endocarditis Pathology
- Infection of endocardium including cardiac valves
- Bacterial is most common cause (staph aureus, strep viridans)
- Improved prognosis with antibiotics
- Also viral and fungi
- BF within heart allows causative organism to infect previously damaged valves/other endothelial surfaces
Endocarditis Classification
by cause or site
-sub-acute and acute forms
Sub Acute Endocarditis
- Pre-existing valve disease
- Longer clinical course (S&S slowly progress)
Acute Endocarditis
- Healthy valves
- Rapidly progressive
- Common in IVDA
Endocarditis Risk Factors
- Valve disease
- Heart disease
- Mitral valve replacement
- Older age
- IVDA
- Prosthetic valves
- Intravascular devices (PICC line)
- Renal dialysis
Vegetation in the Heart
- Fibrin, leukocytes, platelets, microbes adhere to valve or endocardium → parts break off and enter circulation (embolization)
- Valve can’t open/close like it should
- Affects BF through heart
- Risk for development of decreased BF through body
- Septic emboli
Manifestations of Endocarditis
- Flu-like symptoms
- Fever
- Chills
- Weakness
- Malaise
- Fatigue
- Anorexia
- New/worsening systolic murmur
- HF
Subacute Manifestations
- Arthralgias (joint pain)
- Myalgias (muscle pain)
- Back pain
- Abdominal discomfort
- Weight loss
- Headache
- Clubbing of fingers (septic emboli)
- Peripheral edema
- Hematuria
Vascular Manifestations
- Splinter hemorrhages in nail beds (black lines on fingernails; shattered micro emboli)
- Petechiae on hands, fingers, toes, feet
- Osler’s nodes on fingertips/toes (painful red lesions)
- Janeway’s lesions on fingers/toes (painless)
- Roth’s spots (micro emboli in eyes)
Manifestations Secondary to Embolism
- Spleen
- Kidneys
- Limbs
- Brain
- Lungs
- *Acute patients see these signs sooner
Diagnostic Studies
- History for risk factors (especially surgeries)
- Blood cultures: draw 2 sets; determine organism for antibiotics
- CBC with differential: increased WBCs
- ESR & C-reactive protein: inflammatory markers; elevated in endocarditis
- Echo: transesophageal to see vegetation
- ECG: dysrhythmias
- Heart catheterization: visualize valves, cardiac transplant, valve replacement
**IV, LT antibiotics is #1 treatment
Prophylactic antibiotic treatment
dental procedures, URI, tonsillectomy & adenoidectomy, surgical procedures involving infected skin, skin structures, musculoskeletal tissue
