Endocarditis
Topic Included
- Introduction
- Definition Of Endocarditis
- Types Of Endocarditis
- Causes Of Endocarditis
- Pathophysiology Of Endocarditis
- Symptoms Of Endocarditis
- Diagnosis Of Endocarditis
- Medical Treatment Of Endocarditis
- Surgical Management Of Endocarditis
- Nursing Management Of Endocarditis
- Nursing Diagnosis On Endocarditis According To NANDA
- Nursing Interventions Of Endocarditis
Introduction
Endocarditis is an infection of the inner lining of the heart chambers and heart valves, known as the endocardium. It is a serious condition that can lead to significant complications if not treated promptly. The infection is usually caused by bacteria, but it can also be caused by fungi or other microorganisms.
Definition
Endocarditis is defined as an inflammation of the endocardium, typically resulting from an infection. The condition can affect the heart valves and other structures within the heart, potentially leading to severe damage and dysfunction.
Types
1. Infective Endocarditis (IE) :
- Acute Infective Endocarditis : Rapid onset and severe symptoms, often caused by highly virulent organisms like Staphylococcus aureus.
- Subacute Infective Endocarditis : Slower onset with more subtle symptoms, often caused by less virulent organisms like Streptococcus viridans.
2. Non-infective Endocarditis :
- Nonbacterial Thrombotic Endocarditis (NBTE) : Characterized by sterile thrombi on the heart valves, often associated with conditions like malignancy or autoimmune diseases.
- Libman-Sacks Endocarditis : Associated with systemic lupus erythematosus (SLE), characterized by sterile vegetations on either side of the heart valves.
Causes
The primary cause of endocarditis is an infection by microorganisms, predominantly bacteria. Common causative agents include:
- Staphylococcus aureus
- Streptococcus viridans
- Enterococci
- Fungi (e.g., Candida species)
Infective endocarditis typically occurs when bacteria or other pathogens enter the bloodstream and adhere to the endocardium.
Risk Factors
- Existing heart conditions : Congenital heart defects, prosthetic heart valves, or previous episodes of endocarditis.
- Intravenous drug use : Use of contaminated needles can introduce bacteria into the bloodstream.
- Poor dental hygiene : Oral bacteria can enter the bloodstream through inflamed gums or dental procedures.
- Invasive procedures : Medical procedures that involve the bloodstream, such as catheterization or certain surgeries.
- Immunocompromised state : Conditions like HIV/AIDS or immunosuppressive therapy increase susceptibility to infections.
Pathophysiology
Pathophysiology of both infective and non-infective Endocarditis
Infective Endocarditis
Steps -
1. Underlying Damage to Valve Endothelium
- Common predisposing factor.
- Causes include congenital heart defects, rheumatic heart disease, and prosthetic heart valves.
2. Bacteria Adhere to Damaged Endothelium
- Bacteria from bloodstream adhere to exposed subendothelial tissues.
3. Propagation of Bacteria
- Bacterial colonies grow and form vegetations.
- Vegetations are masses of platelets, fibrin, microorganisms, and inflammatory cells.
4. Vegetation Formation
- Promotes activation of the clotting cascade.
- Leads to the deposition of more fibrin and platelets.
5. Fibrin and Platelet Deposition
- Over clusters of bacteria.
- Vegetations grow larger, becoming more destructive.
6. Valve Destruction and Failure
- Vegetations cause direct damage to heart valves.
- May lead to valve dysfunction, heart failure, and embolic events.
Non-Infective Endocarditis
Steps -
1. Valves Usually Undamaged
- Unlike infective endocarditis, the valves are typically structurally intact.
2. Etiology
- Poorly understood.
- Thought to involve multiple mechanisms.
3. Contributing Factors
- Circulating Immune Complexes:
- Autoimmune disorders can lead to immune complex deposition on valves.
- Carcinomatosis:
- Cancer, particularly mucin-secreting adenocarcinomas, can contribute to non-infective endocarditis.
- Hypercoagulable State:
- Conditions that increase blood coagulability can lead to sterile thrombi on valves.
4. Valve Destruction or Failure
- Rare compared to infective endocarditis.
- Usually does not lead to the same extent of valve damage or failure.
Symptoms
- Fever and chills
- Fatigue
- Night sweats
- Heart murmurs (new or changed)
- Shortness of breath
- Persistent cough
- Weight loss
- Petechiae : Small red or purple spots on the skin, caused by tiny blood vessel hemorrhages.
- Osler's nodes: Painful, red, raised lesions on the hands and feet.
- Janeway lesions : Non-tender, flat, red spots on the palms and soles.
- Splinter hemorrhages : Small, linear hemorrhages under the fingernails or toenails.
Diagnosis
1. Clinical Evaluation :
History taking and physical examination to identify signs and symptoms.
2. Blood Cultures :
Multiple sets to identify causative organisms.
3. Echocardiography :
- Transthoracic Echocardiogram (TTE) : Non-invasive, initial test.
- Transesophageal Echocardiogram (TEE) : More sensitive, especially for detecting smaller vegetations or complications.
4. Laboratory Tests :
- Complete blood count (CBC) to check for anemia or elevated white blood cell count.
- Inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).
5. Electrocardiogram (ECG) :
To detect any heart rhythm abnormalities.
6. Imaging :
CT scan or MRI if complications such as emboli are suspected.
Medical Treatment
1. Antibiotic Therapy : Long-term, high-dose intravenous antibiotics tailored to the identified organism.
2. Antifungal Therapy: If the infection is caused by fungi.
3. Surgery :
- Valve repair or replacement if there is significant damage or persistent infection.
- Removal of infected prosthetic material.
4. Supportive Care :
Management of complications such as heart failure or embolic events.
Nursing Management
1. Monitoring : Vital signs, cardiac function, signs of complications (e.g., embolism, heart failure).
2. Administration of Medications : Ensuring timely administration of antibiotics and monitoring for adverse effects.
3. Patient Education : Importance of adherence to treatment, recognizing signs of complications, and preventive measures.
4. Infection Control : Maintaining aseptic techniques during IV therapy and other procedures.
5. Nutrition and Hydration : Ensuring adequate intake to support healing and recovery.
6. Pain Management : Addressing discomfort and providing analgesics as needed.
Nursing Diagnosis According to NANDA
1. Risk for Infection : Related to the presence of an invasive device and immunocompromised status.
2. Decreased Cardiac Output : Related to valvular dysfunction or myocardial involvement.
3. Fatigue : Related to prolonged infection and the body's metabolic response.
4. Activity Intolerance : Related to weakness and cardiovascular impairment.
5. Anxiety : Related to uncertainty about the disease process and prognosis.
Nurse Interventions
1. Infection Control :
- Use of aseptic techniques.
- Monitoring for signs of secondary infections.
2. Cardiac Monitoring :
- Regular assessment of heart sounds and rhythm.
- Monitoring for signs of heart failure or embolic events.
3. Medication Management :
- Accurate administration of prescribed antibiotics.
- Monitoring for and managing side effects of antibiotics.
4. Patient Education :
- Teaching about the importance of completing the full course of antibiotics.
- Educating on the importance of dental hygiene and regular dental check-ups.
- Instruction on recognizing signs of relapse or complications.
5. Nutritional Support :
- Encouraging a balanced diet to support immune function and recovery.
- Providing dietary modifications if needed due to treatment side effects (e.g., nausea).
6. Psychosocial Support :
- Offering emotional support and counseling to address anxiety and stress.
- Involving family in care plans and education to provide a support system.
By addressing these aspects comprehensively, healthcare professionals can effectively manage and treat endocarditis, improving patient outcomes and quality of life.
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