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ENDOCARDITIS

INTRODUCTION
Endocarditis generally occurs when bacteria, fungi or other germs from another part of body, such as mouth,
spread through bloodstream and attach to damaged areas in heart. If it's not treated quickly, endocarditis can
damage or destroy heart valves and can lead to life-threatening complications. Treatments for endocarditis
include antibiotics and, in certain cases, surgery.
Since there are many ways to develop endocarditis, doctor might not be able to pinpoint the exact cause of
condition. However, people at greatest risk of endocarditis usually have damaged heart valves, artificial heart
valves or other heart defects.
DEFINITION
Endocarditis is an infection of the endocardium, which is the inner lining of heart chambers and heart valves.
ETIOLOGY
Bacteria, fungi or other germs that cause endocarditis might enter bloodstream through:
 Everyday oral activities. Activities such as brushing teeth, or other activities that could cause gums to
bleed, can allow bacteria to enter bloodstream — especially if don’t floss or teeth and gums aren't
healthy.
 An infection or other medical condition. Bacteria may spread from an infected area, such as a skin
sore. Other medical conditions, such as gum disease, a sexually transmitted infection or certain intestinal
disorders — such as inflammatory bowel disease — can also give bacteria the opportunity to enter
bloodstream.
 Catheters. Bacteria can enter body through a catheter — a thin tube that doctors sometimes use to inject
or remove fluid from the body. This is more likely to occur if the catheter is in place for a long period of
time.
 Needles used for tattoos and body piercing. The bacteria that can cause endocarditis can also enter
bloodstream through the needles used for tattooing or body piercing.
 Intravenous (IV) illegal drug use. Contaminated needles and syringes are a special concern for people
who use illegal intravenous (IV) drugs, such as heroin or cocaine. Often, individuals who use these types
of drugs don't have access to clean, unused needles or syringes.
 Certain dental procedures. Some dental procedures that can cut gums may allow bacteria to enter
bloodstream.
RISK FACTORS
People at highest risk of endocarditis are those who have:
 Artificial heart valves. Germs are more likely to attach to an artificial (prosthetic) heart valve than to a
normal heart valve.
 Congenital heart defects. If were born with certain types of heart defects, such as an irregular heart or
abnormal heart valves, heart may be more susceptible to infection.
 A history of endocarditis. Endocarditis can damage heart tissue and valves, increasing the risk of a
future heart infection.
 Damaged heart valves. Certain medical conditions, such as rheumatic fever or infection, can damage or
scar one or more of heart valves. This can make them more prone to endocarditis.
 A history of intravenous (IV) illegal drug use. People who use illegal drugs by injecting them are at a
greater risk of endocarditis. The needles used to inject drugs can be contaminated with the bacteria that
can cause endocarditis.
PATHOPHYSIOLOGY
 Endocarditis occurs when germs enter bloodstream, travel to heart, and attach to abnormal heart valves
or damaged heart tissue. Certain types of bacteria cause most cases, but fungi or other microorganisms
also may be responsible.
 Usually, immune system destroys harmful bacteria that make it into bloodstream. Even if bacteria reach
heart, they may pass through without causing an infection. However, bacteria that live in mouth, throat
or other parts of body, such as skin or gut, can sometimes cause serious infections like endocarditis
under the right circumstances.
 Bacteria can more easily attach to the lining of heart (endocardium), if the lining's surface is rough. 're
also more likely to develop endocarditis if have faulty, diseased or damaged heart valves. However,
endocarditis does occasionally occur in previously healthy individuals.
CLINICAL MANIFESTATIONS
Endocarditis may develop slowly or suddenly, depending on what germs are causing the infection and whether
have any underlying heart problems. Endocarditis signs and symptoms can vary from person to person.
Common signs and symptoms of endocarditis include:
 Flu-like symptoms, such as fever and chills
 A new or changed heart murmur, which is the heart sounds made by blood rushing through heart
 Fatigue
 Aching joints and muscles
 Night sweats
 Shortness of breath
 Chest pain when breathe
 Swelling in feet, legs or abdomen
Endocarditis can also cause symptoms that are more uncommon. These include:
 Unexplained weight loss
 Blood in urine, which might be able to see or that doctor might see when he or she views urine under
a microscope
 Tenderness in spleen, which is an infection-fighting abdominal organ just below rib cage on the left
side of body
 Jane way lesions, which are red spots on the soles of feet or the palms of hands
 Osler's nodes, which are red, tender spots under the skin of fingers or toes
 Petechiae (puh-TEE-key-e), which are tiny purple or red spots on the skin, whites of eyes, or inside
mouth
MODIFIED DUKES CRITERIA FOR DIAGNOSIS OF INFECTIVE ENDOCARDITIS
Definitive Endocarditis if,
• Two major or,
• One major and three minor or,
• five minor
Possible Endocarditis if,
• One major and one minor or,
• Three minor
Major criteria
Positive blood culture
 Typical organism from two cultures
 Persistent positive blood cultures taken > 12 hours apart
 Three or more positive cultures taken over more than 1 hour.
Endocardial involvement
 Positive echocardiographic findings of vegetations
 New valvular regurgitation
MINOR CRITERIA
 Predisposition: Predisposing valvular or cardiac abnormality
 Intravenous drug misuse
 Pyrexia ≥38°C (≥100.4°F)
 Embolic phenomenon
 Vasculitis/ immunologic phenomenon
 Blood cultures suggestive: -organism grown but not achieving major criteria
 Suggestive echocardiographic findings
INVESTIGATIONS
Blood test
Blood culture test will be ordered to confirm whether bacteria, fungi, or other microorganisms are causing it.
Other blood tests can also reveal if symptoms are caused by another condition, such as anemia.
Transthoracic echocardiogram
A transthoracic echocardiogram is a non-radiating imaging test used to view heart and its valves. This test
uses ultrasound waves to create an image of heart, with the imaging probe placed on the front of chest. Doctor
can use this imaging test to look for signs of damage or abnormal movements of heart.
Transoesophageal echocardiogram
When a transthoracic echocardiogram doesn’t provide enough information to assess heart accurately, doctor
might order an additional imaging test called a transoesophageal echocardiogram. This is used to view heart by
way of oesophagus.
Electrocardiogram
An electrocardiogram (ECG or EKG) may be requested to get a better view of heart’s electrical activity. This
test can detect an abnormal heart rhythm or rate. A technician will attach 12 to 15 soft electrodes to skin. These
electrodes are attached to electrical leads (wires), which are then attached to the EKG machine.
Chest X-ray
A collapsed lung or other lung problems can cause some of the same symptoms as endocarditis. A chest X-
ray may be used to view lungs and see if they’ve collapsed or if fluid has built up in them. A build-up of fluid is
called pulmonary edema. The X-ray can help doctor tell the difference between endocarditis and other
conditions involving with lungs

Computed Tomography (CT) Scan

Magnetic Resonance Imaging (MRI)


MEDICAL MANAGEMENT
 If the patient is having poor intake of oxygen administer oxygen therapy 4-6 l/m in helping the
patient get supplemented with enough oxygen.
 Administer antibiotic treatment like ampicillin + flucloxacilin +gentamicin.
 Administer paracetamol 1g tds p.o as analgesic that help in relieving pain.
 Administer inotropic drugs like digoxin that help in increasing contractility of the heart.
 The patient can also be administered with morphine which help to decrease anxiety.
NURSING MANAGEMENT
It includes history taking like;
– Subjective data:
– past medical history: patient asked of signs of the disease and the onset of the disease and
review with patient history of risk factors like cardiac failure, shock
– Medication history: has the patient ever taken any medication, what happened afterwards
– Family history: asked of any case at home of the similar conditions
– Social history: social behaviours that can trigger the problem
– Surgical history: if ever operated on
– Objective data: assess for temperature elevations, heart mummer, evidence of cough ,
peripheral edema and embolism, alscultate for heart sound, monitor arterial blood gas, rapid
purse rate,dyspnea, restlessness and manifestation of heart failure
NURSING DIAGNOSIS
 Infective breathing pattern related to inflammation of heart muscle as evidenced by use of accessory
muscle, dyspnea.
 Impaired gaseous exchange related to fluid accumulation in the lungs as evidenced by shortness of
breath
 Decreased cardiac output related to valvular dysfunction as evidenced by poor tissue perfusion
 Imbalanced nutrition less than body requirement related to anorexia as evidenced by loss of
weight.
 Infective breathing pattern related to inflammation of heart muscle as evidenced by use of accessory
muscle, dyspnea.
 Impaired gaseous exchange related to fluid accumulation in the lungs as evidenced by shortness of
breath
 Decreased cardiac output related to valvular dysfunction as evidenced by poor tissue perfusion
 Imbalanced nutrition less than body requirement related to anorexia as evidenced by loss of weight.
NURSING INTERVENTIONS
 Position the patient at semi fowlers position to help in infective breathing through providing enough
room for lung expansion as abdominal contents goes down
 Administer oxygen therapy 4-6 l/min to help pt in breathing effectively through supplementing oxygen
 Monitor arterial blood gas, carbon dioxide, oxygen saturation hourly and document to monitor signs of
respiratory acidosis.
 Encourage and provide small frequent meals reach in proteins helping in repairing worn-out tissues
 Monitor vital signs, heart and lung sound, level of consciousness to evaluate how effectively the organs
like the heart and the lungs are working.
 Schedule nursing activities to allow rest
 Encourage and assist pt to cough and deep breath to promote chest expansion
 provide tepid sponging to reduce raised body temperature by
 evaporation and conduction
 Encourage patient on exercises in order to improve patients mobility through making the body
physically fit
COMPLICATIONS
In endocarditis, clumps of bacteria and cell fragments form in heart at the site of the infection. These clumps,
called vegetation’s, can break loose and travel to brain, lungs, abdominal organs, kidneys or limbs. As a result,
endocarditis can cause several major complications, including:
 Heart problems, such as heart murmur, heart valve damage and heart failure
 Stroke
 Seizure
 Loss of the ability to move part of all of body (paralysis)
 Pockets of collected pus (abscesses) that develop in the heart, brain, lungs and other organs
 Pulmonary embolism — an infected vegetation that travels to the lungs and blocks a lung artery
 Kidney damage
 Enlarged spleen
CONCLUSION
Infection of the endocardial surface of heart characterized by - Colonization or invasion of the heart valves
(native or prosthetic) or the mural endocardium by a microbe, - leading to formation of bulky, friable vegetation
composed of thrombotic debris and organisms - often associated with destruction of underlying cardiac tissue.

BIBLIOGRAPHY
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TMM COLLEGE OF NURSING

MEDICAL SURGICAL NURSING

SEMINAR
ON

ENDOCARDITIS

SUBMITTED ON, SUBMITTED BY,


Mrs. Sindhu C Philip Mrs. Ashisha.C
Associate Professor 2nd year Msc Nursing
TMM CON TMMCON

SUBMITTED ON: 9/5/’19