Endocarditis

Endocarditis

1. ENDOCARDITIS Mrs.D.Melba Sahaya Sweety M.Sc Nursing GIMSAR

2. INTRODUCTION Endocarditis is usually caused by an infection. Bacteria, fungi or other germs from another part of your body, such as your mouth, spread through your bloodstream and attach to damaged areas in your heart. If it's not treated quickly, endocarditis can damage or destroy your heart valves. 

3. DEFINITION Endocarditis is inflammation of the inside lining of the heart chambers and heart valves ( endocardium ). It is also known as infective endocarditis (IE), bacterial endocarditis (BE), infectious endocarditis , and fungal endocarditis

4. ETIOLOGY 1. Staphylococci (s. aureus , S.faecalis , S.epidermidis ) Common injecting organisms include

5. 2. Streptococci 3. Escherichia coli ETIOLOGY Common injecting organisms include

6. ETIOLOGY 4. Gram negative organisms ( klebsiella , pseudomonas,) Common injecting organisms include

7. ETIOLOGY 5. Fungi (Candida, aspergillus ) Common injecting organisms include

8. ETIOLOGY 6.HACEK organisms HACEK refers to a group of fastidious gram-negative coccobacillary organisms. HACEK stand for Haemophilus species, Aggregatibacter species, Cardiobacterium hominis , Eikenella corrodens , and Kingella species. Common injecting organisms include

9. Congenital heart defects Damaged valves by rheumatic fever, atherosclerosis Artificial heart valves May occur after cardiac surgery, invasive procedures (dental procedures, catheterization, prolonged IV therapy) minor surgery, gynecologic examinations, dialysis. May follow after acute infection of the tonsils, gums, teeth, skin, lungs, GIT, GUT Immunocompromised patients I.V Drug abusers (injections) PREDISPOSING RISK FACTORS

10. PATHOPHYSIOLOGY Organism travel in the blood stream Attach to the endothelium lining of the normal heart or an area of defect(heart Valve)  Forms vegetations (clumps of bacteria, fibrin, cellular debris, platelets) Infected clots may break free and travel through the blood stream Growth of vegetation on heart valves

11. Emboli that can lodge to various organs ( kidney,spleen,liver,brain,lungs,coronary atery etc..)  deforms, thicken, stiffen, perforate the valve leaflets PATHOPHYSIOLOGY (cont..) obstruct blood flow and produce organ damage Dysfunctional heart valves

12.  The primary presenting symptoms of infective endocarditis are fever and a heart murmur. CLINICAL MANIFESTATION

13. Clinical feactures related to the infection include Fever ,chills, alternating with sweats, malaise, weakness, anorexia, weight loss, pallor, backache and spleenomegaly . CLINICAL MANIFESTATION

14. Clinical manifestations related to embolization :-( occurs in any part of the body) Stroke, TIA, aphasia Loss of vision form embolization to the brain or retinal artery CLINICAL MANIFESTATION

15. • Roth’s spots :- also known as Litten spots or the Litten sign, are non-specific red spots with white or pale centres, seen on the retina  Myocardial infarction :- (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle. CLINICAL MANIFESTATION

16. Pulmonary embolism :- I t is   a blockage in one of the pulmonary arteries in your lungs .  Splinter hemorrhages   cause long, red streaks down the fingernails. They happen when blood leaks up from under the nails. CLINICAL MANIFESTATION

17. Clubbing of the fingers :- Clubbed fingers is a symptom of disease, often of the heart or lungs which cause chronically low blood levels of oxygen .  CLINICAL MANIFESTATION

18. Osler’s nodes :- (red, painful nodes with a white centre on the pads of fingers, toes, palms or soles) – a late sign of infection. Janeway lesions:-   are irregular, non tender hemorrhagic macules located on the palms, soles, thenar and hypothenar eminences of the hands, and plantar surfaces of the toes CLINICAL MANIFESTATION

19. Subconjunctival Hemorrhage :- A bright red patch appearing in the white of the eye beneath the clear lining of the eye (conjunctiva).A subconjunctival haemorrhage is bleeding underneath the conjunctiva CLINICAL MANIFESTATION

20.    History collection – previous heart disease, chest injury, surgery, prosthetic heart valves. Physical examination- BP, Temperature, Inspection(Osler node, Janeway's lesion, clubbing of finger) DIAGNOSTIC EVALUATION

21. Complete blood count- Increased ESR level CRP test- Increased C-reactive protein level Echocardiogram- Shows chamber enlargement, valvular dysfunction & vegetation DIAGNOSTIC EVALUATION

22. ECG- 1st or 2nd degree atrioventricular block DIAGNOSTIC EVALUATION

23. Chest X ray shows cardiomegaly Blood culture used to detect the microorganism DIAGNOSTIC EVALUATION

24. A. Pharmacological Management Administration of antibiotics- Benzyl Penicillin I/V 1.2 gm 4 hourly Gentamycin I/V 1mg/kg TDS Antipyretics- Inj. Paracetamol TDS Fungal endocarditis requires specific anti-fungal treatment, such as amphotericin B.  MEDICAL MANAGEMENT

25. A. Pharmacological Management  Streptococci: PEN/CEF + GENTA, (VANCO) Staphylococci: MET/OXA + GENTA Empiric therapy : - should focus on S. aureus HACEK/early PVE/fungi : PVE (Prosthetic Valve Endocarditis ) - prolonged (min. 6w) + RIFAMPIN MEDICAL MANAGEMENT

26. Surgical debridement of infected area Replacement of the valve with a mechanical or bio prosthetic artificial heart valve. SURGICAL MANAGEMENT

27. Arrhythmias – atrial fibrillation Glomerulonephritis Stroke ( CVA) Brain abscess COMPLICATIONS Heart failure CHF - most common, due to damage to the aortic, mitral valve Embolic episodes – ischemia and necrosis of organs

28.  Provide comfort measures, Encourage adequate fluids & nutrition CBR if w/ signs of valve dysfunctions (murmurs ) Provide health teachings: cause of infection, prolonged use of antibiotic, prophylactic antibiotics Preventing recurrence of infection (good oral Watch for signs and symptoms of embolization such as hematuria , pleuritic chest pain, left upper quadrant pain, and paresis. NURSING MA NAGEMENT

29. Monitor the patient’s renal status including blood urea nitrogen levels, creatinine clearance levels and urine output. Assess cardiovascular status frequently and watch for signs of left ventricular failure such as dyspnea , hypotension, tachycardia, tachypnea , crackles, neck vein distention , edema , and weight gain. Check for changes in cardiac rhythm or conduction. Evaluate arterial blood gas values as needed to ensure adequate oxygenation. NURSING MA NAGEMENT

30. Acute pain related to inflammation of endocardium and tissue ischemia as evidenced by verbalization,discomfort,facial expresion Decreased cardiac output related to valvular insufficiency & fluid overload as evidenced by dyspnea Activity intolerance related to Inflammation possibly evidenced by generalized weakness & arthralgia . Risk for Ineffective Tissue Perfusion related to Thrombus embolism / vegetation valve endocarditis . NURSING DIGNOSIS