In IE, the vegetations over the valves can break off and embolize to various organs,
resulting in life-threatening complications. These include the following:
1.
2.
3.
4.
5.
Stroke - paralysis on one side
Spinal cord ischemia - paralysis of both legs
Ischemia to the extremities - pain, pallor, and cold foot or arm
Intestinal infarction - abdominal pain
Splenic infarction - left upper-quadrant pain
The nurse or the client (if at home) should report these manifestations immediately to
the HCP.
(Options 2 and 4) IE commonly presents with fever, arthralgias (multiple joints pains),
weakness, and fatigue. These are expected and do not need to be reported during the
initial stages of treatment.
IE clients typically require intravenous antibiotics for 4-6 weeks. Fever may persist for
several days after treatment is started. If the client is persistently febrile after 1-2 weeks
of antibiotics, this must be reported as it may indicate ineffective antibiotic therapy.
(Option 3) Splinter hemorrhages can occur with infection of the heart valves
(endocarditis). They may be caused by vessel damage from swelling of the blood
vessels (vasculitis) or tiny clots that damage the small capillaries (microemboli). The
presence of splinter hemorrhages is not as critical as the macroemboli causing stroke or
painful cold leg.
Educational objective:
IE causes the formation of vegetations on valve and endocardial
surfaces. Embolization to various organ sites can occur. The onset of hemiplegia or
painful, pale, cold foot/leg could indicate embolization and should be reported to the
HCP immediately