Endocarditis

Endocarditis is inflammation of your heart's inner lining, called the endocardium. It's usually caused by bacteria. When the inflammation is caused by infection, the condition is called infective endocarditis. Endocarditis is uncommon in people with healthy hearts.

1. ENDOCARDITIS Dr,.Arjun Patel MPT, DNHE

2. Definition Infective endocarditis is an illness caused by microbial infection of the cardiac endothelial surface.

3. Etiology 1. Infection of abnormal valves Relatively high risk Arotic valve disease Mitral regurgitation + stenosis Congenital heart disease Intermediate risk Mitral valve prolapse Mitral stenosis

4. Tricuspid valve disease Pulmonary valve disease Calcific arotic sclerosis Very low risk Atrial septal defect Cardiac pacemaker 2. Infection of native valves 3. Surgical endocarditis Early prosthetic valve endocarditis Late Prosthetic valve endocarditis

5. 4. Causative Organisms Bacterial:- streptococcus viridian , Streptococcus faecalis and staphylococcus epidermidis Non bacterial:- Ricketssial- coxiella burnetti Fungal - Candida

6. Pathophysiology

7. Clinical features Fever : variable and low grade Anaemia : yellow discoloration of skin. clubbing : of fingers and toes occurs early. splenomegaly Arthralgia : sudden transient pain in joint without any effusion.

8. subconjunctival haemorrhage

9. patechial haemorrhages

10. Investigation Blood cultures :- blood cultures is positive by third day Urine :- Microscopic hematuria Hematology :-May be raised ESR and raised C- reactive protein. Chest x- ray :-Right sided endocarditis , with multiple shadows visible due to an embolic pneumonia. ECG :-MI seen on ECG may be due to coronary embolism.

11. Treatment A. Antibiotics:- Bacterial antibiotic:- Penicillin, cephalosporins , Aminoglycosid B.General measures:- Complete rest in bed High protein diet with added vitamins and iron Small repeated blood transfusions if severe anaemia

12. Fungal endocarditis :- IV Amphotericin and surgical excision of prosthetic valves surgical measure - indication - infection cannot be controlled medically. acute or chronic heart as a result of valve destruction especially aortic valve , septal defects and major emboli.

13. Reference Medicine by Golwalla Textbook of pathology by Harsh mohan Medicine by Davidson