Nursing Flashcard – Infective Endocarditis
background
1) Condition characterized by infection of the endothelium lining of the heart. The
characteristic lesion is the vegetation.
2) Most patients have a pre-existing cardiac pathologic condition (prosthetic heart valve or
patch, congenital heart disease mainly cyanotic or with left-to-right shunt) or are drug
addicts (IV users endocarditis of the tricuspid valve).
3) Valve involvement:
i) left sided : mitral > aortic
ii) right sided: tricuspid > pulmonary
etiology
S. aureus, Strep. epidermidis, gram-negative bacilli, enterococci, Hemophilus influenzae
symptoms
1) fever (low-grade or >100,4°F), chills, night swe ats
2) malaise, weakness, anorexia, weight loss, pallor
3) myalgia, arthralgia
4) progressive valve dysfunction heart failure
5) petechial hemorrhages in the retina (Roth’s spots)
6) tender subcutaneous nodes on finger and toes (Osler’s nodules)
7) symptoms due to organ infarction (cerebral, renal) or peripheral arteries occlusion
diagnostic evaluation
1) echocardiography is the test of choice (identifies vegetations / abscesse)
2) lab: anemia, leukocytosis, blood cultures positive for micro-organisms, elevated ESR &
CRP, proteinuria, microscopic hematuria
complications
1) septic embolic phenomena (cerebral, coronary, peripheral, pulmonary, visceral)
2) perivalvular or myocardial abscess formation with evidence of new heart block
3) dehiscence of a prosthetic valve
4) heart failure (with acute or progressive valve dysfunction, or new valvular insufficiency)
5) uncontrolled sepsis
6) multi-system organ dysfunction
treatment
1) antibiotic prophylaxis before dental, gastrointestinal, gynaecological, and urological
procedures
2) medical therapy
i) stabilize the patient before surgery
ii) organism specific IV antibiotics
3) surgical
i) excision of all infected native / prosthetic infected material
ii) valve or prosthesis repair or replacement
iii) extracardiac (splenic / vertebral / cerebral abscess and mycotic aneurysms)