This document discusses infective endocarditis, which involves infection of the inner lining of the heart called the endocardium. It is more common in people with pre-existing heart conditions or defects. The document defines endocarditis and lists various risk factors. Common causes are bacteria like Staphylococcus aureus and Streptococcus. Symptoms may include fever, joint pain, rashes, and heart complications. Diagnosis involves blood tests, echocardiogram, and physical exam looking for signs like Osler's nodes or Janeway lesions. Treatment is usually long-term antibiotics with surgery sometimes needed to replace infected heart valves. Nursing care focuses on monitoring for complications like embolisms, decreased cardiac output, and managing

1. - MR. MIGRON RUBIN

2. Introduction
Endocarditis or infective endocarditis involves endocardium layer.
Endocardium is inner layer of heart. Endocarditis is uncommon in people
with healthy hearts.

3. Definition
 Endocarditis is infection of endocardial layer of heart.

4. Risk factors
 Previous history of endocarditis
 Prosthetic heart valves
 Cardiomegaly
 Congenital heart disease
 Ventricular septal defect
 Aortic stenosis
 Marfan syndrome

5. Etiology
 Staphylococcus aureus
 Streptococcus viridans
 Coxsackie B Virus
 Candida albicans

6. Pathophysiology
Due to etiological factors like S. aureus, S. viridans etc.
Invasion & adherence of micro-organisms on endothelial surface.
Formation of vegetation consisting of leukocytes, fibrin & platelets.
Left & right sided heart embolization.
Affects various organs of body, sepsis, valvular damage, heart failure & heart
block.

7. Clinical Manifestations
 Osler’s node- Painful red or purple lesions
 Janeway’s lesions-Painless red spots Splinter hemorrhage

8.  Petechiae Clubbing of fingers

9.  Low grade fever & chills
 Headache
 Malaise
 Fatigue
 Arthralgia
 Backache

10. Difference between Janeway’s lesion & Osler’s Node
Characteristics
• Location
• Color
• Pain
• Size
• Tender
• Course
• Culture
• Histology
• Type of
endocarditis
Janeway’s lesion
• Sole, palm & plantar surface of toe
• Red spots
• Absent
• Irregular
• Absent
• Days to weeks
• Positive
• Septic microemboli
• Acute
Osler’s node
• Finger & toe tips
• Red to purple spots
• Present
• 1mm to> 1cm
• Present
• Hours to days
• Negative
• Vasculitis
• Subacute

11. Diagnostic evaluation
 History collection – previous heart disease, chest injury, surgery,
prosthetic heart valves.
 Physical examination- BP, Temperature, Inspection(Osler node, Janeway's
lesion, clubbing of finger)
 Complete blood count- Increased ESR level
 CRP test- Increased C-reactive protein level
 Echocardiogram- Shows chamber enlargement, valvular dysfunction &
vegetation
 Chest X ray shows cardiomegaly
 ECG- 1st or 2nd degree atrioventricular block

12. Management
i. MEDICAL MANAGEMENT
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.
 Non-pharmacological Management:-
 Monitor vitals frequently and respond to the changes.
 Provide adequate rest to avoid exertion.
 Ensure adequate nutritional intake.

13. B. SURGICAL MANAGEMENT:-
 Surgical debridement of infected area
 Replacement of the valve with a mechanical or bio prosthetic artificial
heart valve.

14.  II. Nursing Management
Diagnosis topics-
 Decreased cardiac output related to valvular insufficiency & fluid overload.
 Risk for Ineffective Tissue Perfusion related to Thrombus embolism /
vegetation valve endocarditis.
 Acute pain related to inflammation of endocardium and tissue ischemia.
 Activity intolerance related to Inflammation possibly evidenced by
generalized weakness & arthralgia.