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Endocarditis - Coggle Diagram
Endocarditis
Definition
Prognosis usually depends on extent of
involvement, structures involved, and secondary disorders that occur
Scar formation may cause structural damage
to the heart
Inflammations or infections involving the
heart muscle and its linings, the pericardium and endocardium, may be acute or chronic
Infection of endocardium, heart valves, or a
cardiac prosthesis
Bacterial invasion, fungal invasion in IV drug
abusers
Types
Subacute infective endocarditis
Acquired valvular or congenital cardiac lesions or follow dental, genitourinary, gynaecologic and GIT procedures
Etiology
Infecting organisms include Streptococcus
viridans (normally inhabits the upper resp.
tract), Streptococcus faecalis
(enterococcus), usually found in GI and perineal flora
Rheumatic endocarditis
Commonly affects the mitral valve. Preexisting
rheumatic endocardial lesions are the predisposing factor
Acute infective endocarditis
Results from bacteria follows septic thrombophlebitis, open-heart surgery, or skin, bone and pulmonary infections
Etiology
Staphylococcus
Enterococcus
Pneumococcus
Gonococcus (rare)
Group A nonhemolytic streptococcus (rheumatic
endocarditis)
Staphylococcus aureus, Pseudomonas, Candida fungi and skin saprophytes among IV drug users
Prognosis
With proper treatment
70% patients
recover
Complications
May cause severe valvular
damage heart failure, cerebrovascular or peripheral vascular ischemia, thrombosis and renal failure
Untreated
Fatal
Pathophysiology
Fibrin and platelets cluster on valve tissue
and engulf circulating bacteria or fungi vegetation
May cover the valve surfaces
Destruction of valvular tissue
Extend to chordae tendineae
Rupture leads to valvular insufficiency
Vegetative growth on heart valves
Endocardial lining of heart chamber or endothelium of a blood vessel may embolize
To the spleen, kidneys, CNS, extremities, and lungs
Signs & Symptoms
Osler’s nodes (small raised swollen tender occur on hands and Feet due to vascular occlusion by microthrombi)-5-15%
Roth’s spot (round white retina spots surrounded by
heamorrhage)-2%
Petechiae on the skin (upper anterior trunk, the buccal, pharyngeal, conjunctival mucosa and the nails (splinter hemorrhage)-30%
Janeway lesions (irregular nontender macules on the soles of the feet, palms and fingers)-5%-15%
Discovery of new murmur along with
fever: Classic sign of endocarditis
Persistent cough
Loud regurgitant murmur (80%)
Weakness, fatigue, weight loss, anorexia,
arthralgia, night sweats, shortness of breath, persistent or intermittent fever (90% of patients) may occur for weeks
Nonspecific
Oedema- Feet and hands
Splenic, renal, cerebral, pulmonary infarction, peripheral vascular occlusion due to embolization from vegetating lesions or diseased valve tissue
Investigation
Elevated WBC; abnormal macrophages, elevated ESR; normocytic, normochromic anemia (subacute bacterial endocarditis); rheumatoid factor (occurs in 50% of
patients)
ECG: A/Fib and other arrhythmias
Echocardiography, transesophageal
echocardiography (TEE)
3 or more blood cultures drawn at least 1
hour apart during a 24-hour period
Treatment
Bed rest, antipyretics for fever, sufficient fluid intake
Severe valvular damage, infection of a cardiac prosthesis may require corrective surgery if refractory heart failure develops
IV Antibiotic based on sensitivity studies of the infecting organism/probable organism, 4-6 weeks followed by oral antibiotics
Nursing Care
Obtain patient’s allergy history, blood C&S
Administer antibiotic on time and educate patients on importance of adherence
Monitor temperature, vital signs, cardiac rhythm, CVP, respiratory status (SpO2, lung sounds), peripheral tissue perfusion (capillary refill) and heart sounds
Encourage bed rest, provide calm and quiet environment
Monitor intake and output hourly and renal status
Watch for and report signs of embolization and other signs of relapse that could occur about 2 weeks after treatment stops