Endocarditis is an infection of the inner lining of the heart (endocardium). It is usually caused by bacteria or fungi entering the bloodstream from another part of the body. Common symptoms include fever and heart murmur. Diagnosis involves blood tests, echocardiogram, and blood cultures. Treatment requires long-term antibiotics and may require surgery to replace damaged heart valves. Complications can include heart failure, stroke, kidney damage, and embolisms in other parts of the body.

1. ENDOCARDITIS
Mrs.D.Melba Sahaya
Sweety
M.Sc Nursing
GIMSAR

2. INTRODUCTION
Endocarditis is usually caused
by an infection. Bacteria, fungi
or other germs from another
part of your body, such as your
mouth, spread through your
bloodstream and attach to
damaged areas in your heart. If
it's not treated quickly,
endocarditis can damage or
destroy your heart valves.

3. DEFINITION
• Endocarditis is inflammation of the
inside lining of the heart chambers
and heart valves (endocardium).
• It is also known as infective
endocarditis (IE), bacterial
endocarditis (BE), infectious
endocarditis, and fungal endocarditis

4. ETIOLOGY
1. Staphylococci
(s. aureus,
S.faecalis,
S.epidermidis)
• Common injecting
organisms include

5. 2. Streptococci
3. Escherichia coli
ETIOLOGY
• Common injecting
organisms include

6. ETIOLOGY
• 4. Gram negative
organisms
• (klebsiella,
pseudomonas,)
Common injecting
organisms include

7. ETIOLOGY
• 5. Fungi (Candida,
• aspergillus)
Common injecting
organisms include

8. ETIOLOGY
• 6.HACEK organisms
• HACEK refers to a group
of fastidious gram-negative
coccobacillary organisms.
• HACEK stand for
Haemophilus species,
Aggregatibacter species,
Cardiobacterium hominis,
Eikenella corrodens, and
Kingella species.
Common injecting organisms include

9. • Congenital heart defects
• Damaged valves by rheumatic fever, atherosclerosis
• Artificial heart valves
• May occur after cardiac surgery, invasive procedures
(dental procedures, catheterization, prolonged IV
therapy) minor surgery, gynecologic examinations,
dialysis.
• May follow after acute infection of the tonsils, gums,
teeth, skin, lungs, GIT, GUT
• Immunocompromised patients
• I.V Drug abusers (injections)
PREDISPOSING RISK FACTORS

10. PATHOPHYSIOLOGY
Organism travel in the blood stream
Attach to the endothelium lining of the normal
heart or an area of defect(heart Valve)
Forms vegetations (clumps of bacteria, fibrin,
cellular debris, platelets)
Infected clots may break
free and travel through
the blood stream
Growth of vegetation
on heart valves

11. Emboli that can lodge to
various organs
(kidney,spleen,liver,brain,lung
s,coronary atery etc..)
deforms, thicken,
stiffen, perforate
the valve leaflets
PATHOPHYSIOLOGY (cont..)
obstruct blood flow and
produce organ damage
Dysfunctional
heart valves

12. • The primary
presenting
symptoms of
infective
endocarditis are
fever and a heart
murmur.
CLINICAL
MANIFESTATION

13. • Clinical feactures related
to the infection include
• Fever ,chills, alternating
with sweats, malaise,
weakness, anorexia,
weight loss, pallor,
backache and
spleenomegaly.
CLINICAL
MANIFESTATION

14. Clinical manifestations
related to
embolization:-(occurs
in any part of the body)
• Stroke, TIA, aphasia
• Loss of vision form
embolization to the
brain or retinal artery
CLINICAL
MANIFESTATION

15. • Roth’s spots :- also known as
Litten spots or the Litten sign,
are non-specific red spots with
white or pale centres, seen on
the retina
• Myocardial
infarction :- (MI),
commonly known
as a heart attack,
occurs when blood
flow decreases or
stops to a part of
the heart, causing
damage to the
heart muscle.
CLINICAL
MANIFESTATION

16. • Pulmonary embolism :-
It is a blockage in one of the
pulmonary arteries in your
lungs.
• Splinter hemorrhages
cause long, red streaks down
the fingernails. They happen
when blood leaks up from
under the nails.
CLINICAL
MANIFESTATION

17. • Clubbing of the
fingers :-Clubbed
fingers is a symptom of
disease, often of the
heart or lungs which
cause chronically low
blood levels of oxygen.
CLINICAL
MANIFESTATION

18. • Osler’s nodes :-(red, painful nodes with
a white centre on the pads of fingers,
toes, palms or soles) – a late sign of
infection.
• Janeway lesions:- are irregular, non
tender hemorrhagic macules located on
the palms, soles, thenar and
hypothenar eminences of the hands,
and plantar surfaces of the toes
CLINICAL
MANIFESTATION

19. • Subconjunctival Hemorrhage:-
A bright red patch appearing in the white of
the eye beneath the clear lining of the eye
(conjunctiva).A subconjunctival
haemorrhage is bleeding underneath the
conjunctiva
CLINICAL MANIFESTATION

20. History collection – previous heart
disease, chest injury, surgery, prosthetic
heart valves.
Physical examination- BP, Temperature,
Inspection(Osler node, Janeway's lesion,
clubbing of finger)
DIAGNOSTIC EVALUATION

21. Complete blood count-
Increased ESR level
CRP test- Increased C-
reactive protein level
Echocardiogram-
Shows chamber
enlargement, valvular
dysfunction & vegetation
DIAGNOSTIC EVALUATION

22. • ECG- 1st or
2nd degree
atrioventricular
block
DIAGNOSTIC EVALUATION

23. Chest X ray shows cardiomegaly
Blood culture used to detect the
microorganism
DIAGNOSTIC EVALUATION

24. A. Pharmacological Management
Administration of antibiotics-
 Benzyl Penicillin I/V 1.2 gm 4 hourly
 Gentamycin I/V 1mg/kg TDS
 Antipyretics- Inj. Paracetamol TDS
 Fungal endocarditis requires specific
anti-fungal treatment, such as
amphotericin B.
MEDICAL MANAGEMENT

25. A. Pharmacological Management
 Streptococci: PEN/CEF + GENTA,
(VANCO)
 Staphylococci: MET/OXA + GENTA
 Empiric therapy : - should focus on S.
aureus
 HACEK/early PVE/fungi : PVE
(Prosthetic Valve Endocarditis)
- prolonged (min. 6w) + RIFAMPIN
MEDICAL MANAGEMENT

26. • Surgical debridement of
infected area
• Replacement of the valve
with a mechanical or bio
prosthetic artificial heart
valve.
SURGICAL MANAGEMENT

27. Arrhythmias – atrial
fibrillation
Glomerulonephritis
Stroke ( CVA)
Brain abscess
COMPLICATIONS
Heart failure
 CHF - most common,
due to damage to the
aortic, mitral valve
Embolic episodes –
ischemia and necrosis
of organs

28.  Provide comfort measures,
 Encourage adequate fluids & nutrition
 CBR if w/ signs of valve dysfunctions (murmurs)
 Provide health teachings: cause of infection,
prolonged use of antibiotic, prophylactic
antibiotics
 Preventing recurrence of infection (good oral
 Watch for signs and symptoms of embolization
such as hematuria, pleuritic chest pain, left upper
quadrant pain, and paresis.
NURSING MANAGEMENT

29.  Monitor the patient’s renal status including blood
urea nitrogen levels, creatinine clearance levels and
urine output.
 Assess cardiovascular status frequently and watch
for signs of left ventricular failure such as dyspnea,
hypotension, tachycardia, tachypnea, crackles, neck
vein distention, edema, and weight gain.
 Check for changes in cardiac rhythm or conduction.
 Evaluate arterial blood gas values as needed to
ensure adequate oxygenation.
NURSING MANAGEMENT

30.  Acute pain related to inflammation of endocardium and
tissue ischemia as evidenced by
verbalization,discomfort,facial expresion
Decreased cardiac output related to valvular
insufficiency & fluid overload as evidenced by dyspnea
Activity intolerance related to Inflammation possibly
evidenced by generalized weakness & arthralgia.
Risk for Ineffective Tissue Perfusion related to
Thrombus embolism / vegetation valve endocarditis.
NURSING DIGNOSIS