Endocarditis

Question 1

What layer of the heart is the endocardium?

Answer 1

Innermost

Question 2

What parts of the heart are affected by infective endocarditis?

Answer 2

Heart chambers or valves

Infective endocarditis is an infection of the heart chambers or valves

Question 3

SUBACUTE endocarditis

Answer 3

Affects those with pre-existing valve disease and has a clinical course that can extend over months; MILDER in presentation; CHRONIC

Question 4

ACUTE endocarditis

Answer 4

Affects healthy valves; manifests as a rapidly progressive illness; therapy must be prompt and vigorous

Question 5

Two factors required to get endocarditis?

Answer 5

1. A damaged epithelium (i.e., from valve replacements or defects)
2. A port of entry (i.e., wound, dental procedure, IVDU)

Question 6

Most common causative organisms of infective endocarditis

Answer 6

Staph aureus, strep viridans

Question 7

Aside from bacteria, what other pathogens can cause infective endocarditis?

Answer 7

Fungi, viruses

Question 8

When do clinical manifestations typically occur with endocarditis?

Answer 8

Typically occur within 2 weeks of bacteremia

Question 9

Endocarditis clinical manifestations

Answer 9

Nonspecific
Low-grade fever (90% of patients), chills, weakness, malaise, fatigue, anorexia, arthralgias, myalgias, back pain, abdominal discomfort, weight loss, headache, clubbing of fingers (late manifestation)

Question 10

What are vegetations?

Answer 10

The primary lesions of infective endocarditis. They consist of different cell pieces and microbes that stick to the valve surface. The loss of these fragile vegetations into the circulation results in emboli.

Question 11

Where do left-sided vegetations move to?

Answer 11

Various organs (brain, kidneys, spleen) and extremities (causing limb infarction)

Question 12

Where do right-sided vegetations move to?

Answer 12

Lungs (PE)

Question 13

Two vascular manifestations of endocarditis

Answer 13

1. Splinter hemorrhages
2. Petechiae

Question 14

Splinter hemorrhages

Answer 14

Black/reddish-brown longitudinal streaks in nail beds

Question 15

Petechiae

Answer 15

From micro-embolization of vegetative valves. Can occur in conjunctivae, lips, buccal mucosa, ankles/feet, antecubital, popliteal areas, fingers

Question 16

Three clinical manifestations that are uncommon but very suggestive of infective endocarditis

Answer 16

1. Osler nodes
2. Janeway lesions
3. Roth spots

Question 17

Osler nodes

Answer 17

Tender papulopustules on fingertips or toes

Question 18

Janeway lesions

Answer 18

Flat/macular, painless, small red spots on palms and soles of feet

Question 19

Roth spots

Answer 19

Hemorrhagic retinal lesions

Question 20

Endocarditis clinical manifestations

Answer 20

New-onset murmur (85% of time)
HF (most common complication of infective endocarditis)

Question 21

Endocarditis history and diagnostic tests

Answer 21

1. History: recent (3-6 mo.) history of dental, urological, surgical, or gynecologic procedure; IVDA
2. Positive blood cultures (3 blood cultures drawn over a period of 1 hour from 3 different sites will be positive in most patients with infective endocarditis)
3. Echocardiogram (evidence of endocardial enlargement)

Question 22

Who should be prophylactically treated for endocarditis?

Answer 22

Patients with a history of a prosthetic heart valve, infective endocarditis, congenital heart disease, or heart transplant

Question 23

Under what situations should patients get prophylactic treatment for endocarditis?

Answer 23

1. Oral-dental work
2. Respiratory-respiratory tract incision (biopsy), tonsillectomy, adenoidectomy
3. GI & GU-wound infection, UTI

Question 24

Endocarditis drug therapy

Answer 24

Typically hospitalized initially and given IV antibiotics
Complete eradication may take weeks
Relapses are common

Question 25

Endocarditis nursing care

Answer 25

Identify and educate high-risk individuals to avoid infections, have adequate rest periods, have good oral hygiene, and notify HCP before dental procedures.

Refer patients with IVDA for rehab

Question 26

Endocarditis nursing care: home care

Answer 26

May include IV antibiotics
Have patient monitor for nonspecific s/s