ENDOCARDITIS

1. P.PADMAPRIYA
PROFESSOR
NHCON

2.  Definition
Inflammation of the endocardium, may
involve any portion of the endothelial lining
of the heart but usually affect the valves.

3. SUBACUTE ACUTE
 Longer clinical course,
more insidious onset
 Caused by low
virulence organism
 Shorter clinical course,
more rapid onset
 Caused by more
virulence organism

4.  Bacterial causes
- Staphylococcus aureus
- Streptococcus viridans
- Streptococcus pyogens
- Streptococcus pneumoniae
 Other pathogens
Fungi, chlamydiae, rickettsiae & viuses

5. CARDIAC CONDITIONS NON CARDIAC DISEASES
 RHD
 Aortic valve
abnormalities
 Mitral valve prolapse
 Cyanotic congenital
heart diseases
 Degenerative heart
diseases
 Intra venous drug
abuse
 Nosocomial bacteremia

6. Damage to endothelial surface from anatomic
or traumatic changes
Primary focus of infection from causative
organism adhering to valve surface
(bacteria,fungi etc)
Formation of
vegetations consisting
of fibrin, leukocytes,
platelets & microbes
on valve surface &
endocardium
Left side
heart
embolizati
on
Right side
heart
embolizat
ion
Brain, limb, kidney,
liver, spleen
Lungs

7. Management Local valve damage
antibiotics
Healing Infiltration to supporting structures
Sepsis, hemodynamic compromise, Heart block

8. •Fever, chills
•Malaise & fatigue
•Anorexia & weight loss
•Back pain
•Headache
•Clubbing of fingers

9. • Black longitudinal streak that
occur in the nail beds
Splinter
haemorrhage
• Common in conjunctivae,
lips, buccal mucosa, palate,
over the ankles & feet, the
antecubital & popliteal areas
Petechiae due
to micro
embolism

11. OSLER’S NODES
Painful,
tender,red/purple,
pea size lesions
found on the
fingertips or toes
Janway’s
lesion
Flat, small,red
spots found
on palms &
soles
Roth’s spots
Hemorrhagic
retinal
lesions

12. • Sharp left upper quadrant pain
• Spleenomegaly
SPLEEN
• Flank pain
• Hematuria
KIDNEY
• Hemiplegia, ataxia, aphasia
• Visual changes & change in LOC
BRAIN

13.  Recent health history
 Physical examination
 Blood culture – 3 sets of blood culture over
24 hrs
 ESR & WBC count
 Echocardiography (TEE) – detects vegetation &
abscess on the valve
 Chest x-ray – enlarged heart
 ECG – shows AV block
 Cardiac catheterization
 Proteinuria & positive rheumatoid factor

14.  Antibiotic prophylaxis ( before dental &
surgical procedures)
 Appropriate IV antibiotics in specific duration
 In addition to brushing and flossing, regular
dental exams are an important part of
maintaining good oral health
 Fever persist – Acetaminophen, fluids
 Complete bedrest

15. Adult Prophylaxis: Dental, Oral, Respiratory, Esophageal
Standard Regimen
Amoxicillin 2g PO 1h before procedure or
Ampicillin 2g IM/IV 30m before procedure
Penicillin Allergic
Clindamycin
600 mg PO 1h before procedure or
600 mg IV 30m before
Cephalexin OR Cefadroxil 2g PO 1 hour before
Cefazolin 1.0g IM/IV 30 min before procedure
Azithromycin or Clarithromycin 500mg PO 1h before

16.  Removal of abscess or infected tissues
 Valve replacement followed by prolonged
drug therapy.

17. THANK YOU