Endocardits

1. ENDOCARDITS

2. Endocarditis is an inflammation of the inner layer
of the heart, the endocardium. It usually involves
the heart valves (native or prosthetic valves).

3. TYPES
1. Infective endocarditis
2. Non-infective endocarditis

4. Infective endocarditis
• Previously known as bacterial endocarditis
• Infectious endocarditis involves the heart valves
and is most commonly found in people who
have underlying heart disease

5. CLASSIFICATION
1.Sub-acute bacterial endocarditis
2.Acute bacterial endocarditis

6. Subacute bacterial
endocarditis (SBE)
• usually develops insidiously and progresses
slowly (i.e, over weeks to months
• Typically affect those with preexisting valve
damage

7. Acute bacterial
endocarditis (ABE)
• usually develops abruptly and progresses
rapidly (ie, over days)
• A source of infection or portal of entry is often
evident.

8. Etiologic factors
• Causes by gram- ve, gram+ve bact & fungi.
• Most often caused by Staphylococcus aureus and
streptococcus viridans
• Fungi
candida albicans
• Viruses
coxsackie B virus

9. Predisposing factors
• Cardiac conditions
prosthetic valves
congenital heart diseases
pacemakers
cardiomyopathy
• Non cardiac conditions
IV Drug abuse
intravascular devices
procedures like dental extraction, tonsillectomy etc..

12. Clinical manifestations
• Low grade fever
• Chills
• Weakness
• Malaise
• Fatigue
• Anorexia
• clubbing

13. Vascular manifestations
splinter haemorrhages- black longitudinal streaks in
the nail beds
Oslers nodes- painful, tender, red , pea shaped
lesions found on the fingertips or toes
Janeway’s lesions- flat, painless, small, red spots
found on the palms and soles
Roth spots- haemorrhagic retinal lesions on
fundoscopic examination

18. Diagnosis
• History collection
dental, urologic,surgical gynaecological procedure
past 3-6 months
history of CVD, related procedures
• Physical examination
• laboratory test
blood culture
total blood count
ESR
CRP
• ECHOCARDIOGRAM

19. Duke Criteria
• Positive blood culture
presence of Cardiac murmer
intracardiac mass/vegetation on echo
• ECG- AV BLOCK
• XRAY- CARDIOMEGALY

20. MANAGEMENT
• Prophylatic treatment
2 g of amoxicillin (Amoxil) 1 hour before
dental, oral, respiratory, or esophageal
procedures.
• If the patient is allergic to penicillin, methicillin
clindamycin cephalexin ,azithromycin
,clarithromycin may be used

21. Pharmacologic
management
• Antibiotic therapy is usually administered
parenterally in a continuous intravenous infusion
for 2 to 6 weeks
eg- pencillin G
ceftriaxone
vancomycin

22. Surgical management
• After the patient recovers from the infectious process,
seriously damaged valves may need to be replaced
• Mitral valve replacement
• Aortic valve replacement

23. Nursing management
• Hyperthermia related to infection of cardiac tissue as
evidenced by elavated temp,chills,malaise, tachycardia
• Decreased cardiac output related to altered rhythm,
valvular insufficiency as evidenced by
tachycardia,murmer
• Deficient knowledge related to lack of experience and
exposure of information about disease and treatment
process