ENDOCARDITIS

1. Endocarditis
• Endocarditis is a life-threatening
inflammation of the inner lining of the
heart's chambers and valves. This lining is
called the endocardium.
• Endocarditis is usually caused by an
infection. Bacteria, fungi or other germs
get into the bloodstream and attach to
damaged heart valves or other heart
defects.
• Without quick treatment, endocarditis can
damage or destroy the heart valves

5. Symptoms
Common symptoms of endocarditis include:
Aching joints and muscles
Chest pain when you breathe
Fatigue
Flu-like symptoms, such as fever and chills
Night sweats
Shortness of breath
Swelling in the feet, legs or belly
A new or changed whooshing sound in the
heart (murmur)

6. • Less common endocarditis symptoms can include:
• Unexplained weight loss
• Blood in the urine
• Tenderness under the left rib cage (spleen)
• Painless red, purple or brown flat spots on the soles bottom of the
feet or the palms of the hands (Janeway lesions)
• Painful red or purple bumps or patches of darkened skin
(hyperpigmented) on the tips of the fingers or toes (Osler nodes)
• Tiny purple, red or brown round spots on the skin (petechiae), in the
whites of the eyes or inside the mouth

7. • Janeway lesions aneway lesions are irregular, nontender
hemorrhagic macules located on the palms, soles, thenar
and hypothenar eminences of the hands, and plantar
surfaces of the toes. They typically last for days to weeks.
They are usually seen with the acute form of bacterial
endocarditis.
The lesions are believed to be caused by septic microemboli
from the valvular lesion.
Histologically, Janeway lesions consist of microabscesses in
the dermis with thrombosis of small vessels without
vasculitis.

8. • Osler nodes are distinguished clinically from Janeway
lesions (Table 1),2 and are usually red-purple, tender,
slightly raised cutaneous nodules, often with a pale
centre
• The underlying cause of the nodes has been debated
since Osler first proposed micro-embolisation as a
cause (this is the scattering of tiny particles around the
bloodstream). Early reports favoured an allergic or
immunological cause, but more recent reports have
isolated bacteria from within the nodules.
• They are usually situated at the tips or sides of fingers
or toes, or at the thenar and hypothenar eminences.
• They are mainly seen in the subacute form of
endocarditis and last for hours to several days.

10. • Splinter hemorrhages are tiny streaks of blood
underneath your nail plate. They resemble thin
wooden splinters.
• Trauma is the most common cause of splinter
hemorrhages, but underlying health conditions
can cause them too.
• Splinter hemorrhages occur when small blood
vessels called capillaries under the skin beneath
your nail (nail bed) burst due to damage.
• When blood vessels under your nail bed sustain
damage, splinter hemorrhages can occur.

11. Causes
• Endocarditis is usually caused by an infection with bacteria, fungi or
other germs. The germs enter the bloodstream and travel to the
heart. In the heart, they attach to damaged heart valves or damaged
heart tissue.
• Usually, the body's immune system destroys any harmful bacteria that
enter the bloodstream. However, bacteria on the skin or in the
mouth, throat or gut (intestines) may enter the bloodstream and
cause endocarditis under the right circumstances.

12. Risk factors
• Chambers and valves of the heart
• Chambers and valves of the heartEnlarge image
• Many different things can cause germs to get into the bloodstream
and lead to endocarditis. Having a faulty, diseased or damaged heart
valve increases the risk of the condition. However, endocarditis may
occur in those without heart valve problems.

13. Risk factors for endocarditis include
• Older age. Endocarditis occurs most often in adults over age 60.
• Artificial heart valves. Germs are more likely to attach to an artificial (prosthetic) heart valve than to a regular heart valve.
• Damaged heart valves. Certain medical conditions, such as rheumatic fever or infection, can damage or scar one or more of
the heart valves, increasing the risk of infection. A history of endocarditis also increases the risk of infection.
• Congenital heart defects. Being born with certain types of heart defects, such as an irregular heart or damaged heart valves,
raises the risk of heart infections.
• Implanted heart device. Bacteria can attach to an implanted device, such as a pacemaker, causing an infection of the heart's
lining.
• Illegal IV drug use. Using dirty IV needles can lead to infections such as endocarditis. Contaminated needles and syringes are
a special concern for people who use illegal IV drugs, such as heroin or cocaine.
• Poor dental health. A healthy mouth and healthy gums are essential for good health. If you don't brush and floss regularly,
bacteria can grow inside your mouth and may enter your bloodstream through a cut on your gums. Some dental procedures
that can cut the gums also may allow bacteria to get in the bloodstream.
• Long-term catheter use. A catheter is a thin tube that's used to do some medical procedures. Having a catheter in place for a
long period of time (indwelling catheter) increases the risk of endocarditis.

14. What tests will be done to diagnose endocarditis?
Blood cultures that show bacteria or microorganisms that healthcare providers often see with
endocarditis. Blood cultures — blood tests taken over time — allow a laboratory to isolate the
specific bacteria that are causing your infection. To secure a diagnosis, the lab must take blood
cultures before you start taking antibiotics.
Complete blood count, which can tell your provider if you have an unusually high number of white
blood cells. This can mean you may have an infection.
Blood tests for substances like C-reactive protein can show you have inflammation.
Echocardiogram (ultrasound of the heart), which may show growths (vegetations on your valve),
abscesses (holes), new regurgitation (leaking) or stenosis (narrowing), or an artificial heart valve
that has begun to pull away from your heart tissue. Sometimes providers insert an ultrasound probe
into your esophagus or “food pipe” (transesophageal echo) to get a closer, more detailed look at
your heart.
Checking heart valve tissue to find out which kind of microbe you have.
TEE.
Positron emission tomography (PET) or nuclear medicine scans to create images using radioactive
material that can show an infection’s location.

15. Complications
• In endocarditis, irregular growths made of germs and cell pieces form a mass in the
heart. These clumps are called vegetations. They can break loose and travel to the brain,
lungs, kidneys and other organs. They can also travel to the arms and legs.
• Complications of endocarditis may include:
• Heart failure
• Heart valve damage
• Stroke
• Pockets of collected pus (abscesses) that develop in the heart, brain, lungs and other
organs
• Blood clot in a lung artery (pulmonary embolism)
• Kidney damage
• Enlarged spleen

16. Prevention
• can take the following steps to help prevent endocarditis:
• If you develop any symptoms of infection — especially a fever that
won't go away, unexplained fatigue, any type of skin infection, or
open cuts or sores that don't heal properly.
• Take care of teeth and gums. Brush and floss teeth and gums often.
Get regular dental checkups. Good dental hygiene is an important
part of maintaining your overall health.
• Don't use illegal IV drugs. Dirty needles can send bacteria into the
bloodstream, increasing the risk of endocarditis.

17. Preventive antibiotics
• high risk of endocarditis and need antibiotics before dental work if
you have:
• A history of endocarditis
• A mechanical heart valve
• A heart transplant, in some cases
• Certain types of congenital heart disease
• Congenital heart disease surgery in the last six months

18. How is bacterial endocarditis treated?
• Endocarditis can be life-limiting. It needs quick treatment to prevent damage heart valves and more serious
complications.
• Antibiotic treatment of infectious endocarditis depends on whether the involved valve is native or
prosthetic, as well as the causative microorganism and its antibiotic susceptibilities
• After taking blood cultures, will start intravenous (IV) antibiotic therapy. They’ll use a broad-spectrum
antibiotic to cover as many suspected bacterial species as possible. As soon as they know which specific type
of organism you have, they’ll adjust your antibiotics to target it. Usually, patients’ll receive IV antibiotics for
as long as six weeks to cure their infection.
• Common blood culture isolates include Staphylococcus aureus, viridans Streptococcus, enterococci, and
coagulase-negative staphylococci.
• Doctors will monitor symptoms throughout their’s therapy to see if this treatment is effective. They’ll also
repeat blood cultures.
• If endocarditis is caused by a fungal infection, antifungal medication is given. Some people need lifelong
antifungal pills to prevent endocarditis from returning.

19. • If endocarditis damages heart valve and any
other part of heart, you may need surgery to
fix heart valve and improve heart function.
Depending on patients’ specific condition, they
may recommend heart valve repair or
replacement. Heart valve replacement uses a
mechanical valve or a valve made from cow, pig
or human heart tissue (biologic tissue valve).