cadiovascular system topic ENDOCARDITIS.ppt

cadiovascular system topic ENDOCARDITIS.ppt

1. Infective endocarditis 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
Infective Endocarditis

2. Endocarditis can be broken down
into the following categories:
Native valve (acute and
subacute) endocarditis
Prosthetic valve (early and late)
endocarditis
Endocarditis related to
intravenous drug use
Classification

3. Native valve acute endocarditis
usually has an aggressive course.
Virulent organisms, such as
Staphylococcus aureus and group B
streptococci, are typically the
causative agents of this type of
endocarditis.
Native valve endocarditis (acute and
subacute)

4. Sub acute endocarditis usually has a
more sluggish course than the acute
form. Alpha-hemolytic streptococci
or enterococci, usually in the setting
of underlying structural valve
disease, typically are the causative
agents of this type of endocarditis.
Sub acute endocarditis

5. Early prosthetic valve endocarditis
occurs within 60 days of valve
implantation. Staphylococci, gram-
negative bacilli, and Candida species
are the common infecting
organisms.
Prosthetic valve endocarditis (early
and late)

6. Late prosthetic valve endocarditis
occurs 60 days or more after valve
implantation. Staphylococcus
epidermidis, alpha-hemolytic
streptococci, and enterococci are
the common causative organisms.
Prosthetic valve endocarditis (early
and late)

7. Endocarditis in intravenous drug abusers
commonly involves the tricuspid valve. S
aureus is the most common causative
organism
Infective endocarditis generally occurs as a
consequence of nonbacterial thrombotic
endocarditis, which results from turbulence
or trauma to the endothelial surface of the
heart.
Endocarditis related to intravenous
drug use

8. Most common symptoms - fever (90% of
cases) and chills
Anorexia, weight loss, malaise, headache,
myalgias, night sweats, shortness of breath,
cough, or joint pains are common complaints
Dyspnea, cough, and chest pain are common
complaints of intravenous drug users who
have infective endocarditis
Signs and symptoms

9. Primary cardiac disease may
present with signs of congestive
heart failure due to valvular
insufficiency
Heart murmurs are heard in
approximately 85% of patients
S&S Cont’d

10. splinter hemorrhages and
purpuric papules on the foot
of a 10 year old boy with
acute bacterial endocarditis

11. Splinter hemorrhages(Panel A) are normally seen
under the fingernails. They are usually linear and red
for the first two to three days and brownish
thereafter.
Panel B shows conjunctival petechiae.
Osler's nodes (Panel C)are tender, subcutaneous
nodules, often in the pulp of the digits or the thenar
eminence.
Janeway's lesions (Panel D) are nontender,
erythematous, hemorrhagic, or pustular lesions,
often on the palms or soles

12. baseline studies, such as a complete blood
count (CBC), electrolytes, creatinine,
glucose, and coagulation panel
Blood cultures: Two sets of cultures have
>90% sensitivity when bacteremia is present
 Three sets of cultures improve sensitivity
and may be useful when antibiotics have
been administered previously
Investigations

13. Echocardiogram
Transthoracic echocardiography
has a sensitivity of approximately
60%. Transesophageal
echocardiography has a
sensitivity of more than 90% for
valvular lesions
Investigations cont’d

14. Empiric antibiotic therapy is chosen
based on the most likely infecting
organisms
 Native valve disease usually is treated
with penicillin G and gentamicin for
synergistic treatment of streptococci
Medical management

15. Patients with a history of IV drug
use may be treated with nafcillin
and gentamicin to cover for
methicillin-sensitive staphylococci.
Medical Mgt Cont’d

16. Infection of a prosthetic valve may
include methicillin-resistant
Staphylococcus aureus; thus,
vancomycin and gentamicin may be
used, despite the risk of renal
insufficiency
Rx Cont’d

17. Rifampin also may be helpful in
patients with prosthetic valves or
other foreign bodies; however, it
should be used in addition to
vancomycin or gentamicin.
Rx Cont’d

18. prophylaxis against infective endocarditis in
patients at higher risk. Patients at higher risk
include those with the following conditions:
Presence of prosthetic heart valve
History of endocarditis
History of rheumatic heart disease
Congenital heart disease with a high-pressure
gradient lesion
Mitral valve prolapse with a heart murmur
Rx Cont’d

19. prophylaxis in patients before they undergo
procedures that may cause transient bacteremia,
such as the following:
Ear, nose, and throat (ENT) procedures
associated with bleeding, including dental
manipulations and nasal packing
Incision and drainage of an abscess
Anoscopy and Foley catheter placement when a
urinary tract infection is present or suspected
Rx Cont’d