Endocarditis

Definition :-
Endocarditis is aninflammatory process of the
endocardium,especially the valves.
Infective endocarditis (IE) is defined as an infection of
the endocardial surface of the heart, which may
include one or more heart valves, the mural
endocardium, or a septal defect.
Causes:-
Types of infective endocarditis
1)Sub acute bacterial endocarditis:-
Develops gradually over several weeks or
months,usually caused by streptococcus viridans.
2) Acute bacterial endocarditis- Caused by
staphylococus aureus.
3)Native valve endocarditis-an infection of a
damaged valve.
4)Prosthetic valve endocarditis-an infection of the
prosthetic valve.
5) Nonbacterial thrombotic endocarditis:- caused
by sterile thrombotic lesions that may develop in
people with cancer or other chronic diseases.
Etiology and risk factors

 Staphylococcus aureus
 S. Faecalis
 S. Epidermis
 Streptococi
 Escherichia coli
 Klebsiella
 Fungi- candida aspergillus.
 Procedures like –barium enemas,
colonoscopy,urethrotomy are associated
with infective endocarditis.
Pathophysiology
Organisms enters into the blood stream through
oral /Iv line/suctioning/procedures

Colonization process on the endothelium,

The bacteria get attached within the layers of fibrin

and platelets in the endothelial layer.

Forms clots and damage the heart valves and leavelets.

Infection extends to aorta /pericardium.

HF
Symptoms
 Fever
 fatigue
chills,
Weakness
aching joints and muscles,
night sweats,
edema (fluid collection) in the leg(s), foot (feet), and
abdomen,
malaise,
shortness of breath, and
occasionally, scattered small skin lesions.
 Spleenomegaly.
 Perforation of the valve leaflet
Obstuction of blood flow due to tmrombus/emboli
 ataxia
 Roth’s spots- white/yellow centre surrounded by a
bright red,irregular halo seen by ophthalmoscope.
 Pulmonary embolus-associated with right sided
infective endocarditis.
 Splinter hemorrhages- look like tiny splinters
under the nail.
 Osler’s nodes- painful,erythematous,peasized
nodules on tips of the fingers and toes.
 Clubbing of fingers.
 Janeway’s lesions.- flat, small,nontender red spots
on the palms of the hands and soles of the feet.
Diagnostic evaluation
Blood culture-to find out presence of
bacteria,fungus,yeast.
ECG -Look for evidence of ischemia, conduction delay, and
arrhythmias.

Echocardiogram
Chest x-ray-to find out HF.
ESR and CRP
Urinalysis
Medical management
Parenteral antibiotics:-
Penicillinand ceftriazone and gentamycin/vancomycin-
given through IV for 4 to 6 weeks.
Surgery- to remove the infected part.
Complications
Emboli
Local spread of infection
Metastatic spread of
infection
Acute S. aureus IE with perforation of the
arthritis aortic valve and aortic valve vegetations

Acute S. aureus IE with mitral valve ring

abscess extending into myocardium
Nursing management
1)Assess ment on hemodynamic stability,
Levels of comfort, coping ability, potential for self care.
2) Assess pulserate,dyspnoea,restlessness,HF,auscultate
heat for every 8 hrs for murmurs.
3) Encourage the patient to
eat nutritious diet,
drink sufficient fluids,
rest mentally and physically.