Infective Endocarditis

Question 1

Infective or Bacterial Endocarditis (IE)

Answer 1

An infection of the heart valves, or the endocardial surface of heart.
Blood flow turbulence within heart allows causative organism to infect valves or endothelial surfaces

Question 2

Acute IE

Answer 2

develops suddenly and may become life threatening within days

Question 3

Subacute IE (chronic)

Answer 3

Develops over weeks or months

Question 4

4 categories of IE (informs site of infection, presence of device, mode of infection)

Answer 4

1. Left-sided native valve IE
2. Left-sided prosthetic valve IE
3. Right-sided IE (includes IV drug use)
4. Intracardiac & intravascular devices (pacemaker, defibrillator)

Question 5

Endocardium

Answer 5

inner most layer of tissue that lines the chamber of the heart

Question 6

What organism is responsible for IE?

Answer 6

Gram + bacterial organisms are responsible for > 80% of IE
typically easier to kill than gram negative and knowing if it is a gram positive bacterial organism a lot of antibiotics are more specific to that.

Question 7

Principle Risk Factors for IE (6)

Answer 7

Prior endocarditis, prosthetic valves, acquired valvular disease, congenital heart defects, cardiac lesions, IV drug use

Question 8

IE Patho: Vegetations

Answer 8

primary lesions of IE
- fibrin, leukocytes, platelets, microbes
can form emboli when they fall off.

Question 9

IE: emboli

Answer 9

portion of vegetation falls off into circulation (22-50%)
Risk is greatest within the first few days of commencing antimicrobial therapy

Question 10

where does emboli go in left-sided IE

Answer 10

brain, kidneys and spleen and small peripheral veins of the arm and leg.
left-sided IE is most common with bacterial infection

Question 11

where does emboli go in right-sided IE

Answer 11

to the lungs
Right-sided is primarily caused by IV use of illicit drugs.

Question 12

Most common causative organism of IE related to IV drug use?

Answer 12

Staphylococcus aureus

Question 13

Nonspecific symptoms of IE (9)

Answer 13

chills, weakness, night seat, SOB, malaise, fatigue, anorexia, weight loss
Low grade fever in > 90% may be absent in immunocompromised or older adults

Question 14

Four unique signs of IE

Answer 14

Splinter hemorrhages
Osler’s nodes
Janeway’s lesions
Petechiae

Question 15

Splinter hemorrhages

Answer 15

longitudinal black streaks in nail bed

Question 16

Osler’s Nodes

Answer 16

painful, red or purple pea-sized lesions that last 1-2 days located on pads of fingers and toes

Question 17

Janeway’s Lesions

Answer 17

flat painless small red spots on the palms of the hands and soles of the feet.

Question 18

Petechia

Answer 18

conjuctiva, inside of the eyelid and buccal mucosa

Question 19

Manifestations of emboli to the spleen

Answer 19

sharp left upper quadrant pain and an enlarged spleen

Question 20

manifestations of emboli to the kidney

Answer 20

pain in the flank, blood in urine and increased BUN

Question 21

Diagnosis of IE (6)

Answer 21

Health hx (recent surgeries or dental work, hx of valvular disease, rheumatic fever, or congenital heart defects or IV drug use, intracardiac prostetic device, resp or urinary infections, recent cardiac catheterization)
- lab data especially blood cultures
- echo
- ECG
- Chest x-ray
- Possible cardiac catheterization to evaluate coronary artery patency and valvular function when surgery is being considered

Question 22

Prophylactic Treatment of IE

Answer 22

Abx prophylaxis for pts with specific cardiac conditions (ie. prosthetic heart valves, hx of congenital HD) prior to certain surgical or dental procedures

Question 23

Drug Therapy for IE

Answer 23

The successful Tx of the infectious endocarditis is dependent on identifying the causative organism
Abx treatment should be started as soon as results of blood culture returns or if IE highly likely
Long term tx needed for eradicating dormant bacteria clustered within vegetation. Complete eradication takes weeks to achieve.
Valve replacements are needed in more than 25% of cases

Question 24

Overall goal of collaborative care in IE (3)

Answer 24

Normal or baseline cardiac function
ADL without fatigue
Prevent recurrence of endocarditis

Question 25

Collaborative care & Nursing management: Health Promotion

Answer 25

teaching is critical. Avoid people with infections. Report any early signs of infection. Good oral hygiene. Regular dental visits. Inform their providers of hx of endocarditis before any procedure. Prophylactic treatment before any surgery is important. If they have hx of IV drug use they need a drug treatment program

Question 26

Collaborative care & Nursing management: Ambulatory & Home Care

Answer 26

• Abx treatment for 4-6 weeks
• Adequate physical and emotional rest at home
• Repeat blood cultures - assess effectiveness of abx therapy