SlideShare a Scribd company logo
1 of 39
Download to read offline
Infective
Endocarditis
By-
Shashi Prakash
I Yr. M.Sc. (N)
ILBS
• Endocarditis is an inflammation of the inner layer of the
heart, the endocardium. It usually involves the heart
valves (native or prosthetic valves). Other structures
which may be involved include the interventricular
septum, the chordae tendinae, the mural endocardium,
or even on intracardiac devices.
INFECTIVE ENDOCARDITIS
• Infectious endocarditis involves the heart valves.
• Sources of the infection may be transient bacteremia,
which is common during dental, upper respiratory,
urologic, and lower gastrointestinal diagnostic and
surgical procedures.
• The infection can cause growths on the heart valves,
the lining of the heart, or the lining of the blood
vessels. These growths may be dislodged and send
clots to the brain, lungs, kidneys, or spleen.
Pathophysiology
• Is occur typically at sites of prexisting endocardial
damage. However ,infection in previously normal heart
occur by S. aureus.
• Infection tend to occur at site of endothelial damage
because these area attract deposit of platelets and
fibrin, which are vulnerable to colonisation by blood
born organisms.
• Adjacent tissue are destroyed and abscess may form,
valve regurgitation may develop or increased.
• If the affected valve is damage by tissue
distortion.
•Extra cardiac manifestations e.g. vacuities,
infarcts of skin, spleen ,kidney and brain due to
emboli or immune complex deposits.
CLASSIFICATION
• Sub-acute bacterial endocarditis
• Acute bacterial endocarditis
• Post operative endocarditis
Subacute bacterial endocarditis (SBE)
• Although aggressive, usually develops insidiously and
progresses slowly (i.e, over weeks to months).
• Often, no source of infection or portal of entry is evident.
• SBE is caused most commonly by streptococci (especially
viridans, microaerophilic, anaerobic, and nonenterococcal
group D streptococci and enterococci) and less commonly by
S. aureus, Staphylococcus epidermidis
• SBE often develops on abnormal valves after
asymptomatic bacteremia due to periodontal, GI, or GU
infections.
Acute bacterial endocarditis (ABE)
•Usually develops abruptly and progresses rapidly
(i.e., over days).
•A source of infection or portal of entry is often
evident. When bacteria are virulent or bacterial
exposure is massive, ABE can affect normal valves.
•It is usually caused by S. aureus, group A
hemolytic streptococci, pneumococci, or gonococci.
Post operative or PVE endocarditis:
•Develops in 2 to 3% of patients within 1 yr after
valve replacement and in 0.5%/yr thereafter.
•It is more common after aortic than after mitral
valve replacement and affects mechanical and
bioprosthetic valves equally.
Causes
•Fungus e.g. candida, aspagellus
•Gram negative organisms e.g. pseudomonas
•Bacteria's e.g. staphylococci
•Acute rheumatic fever which cause enlarged and
tender lymph nodes, damages the valves
•Congenital heart disease
Risk Factors
•Previous heart damage
•Dental procedures which lead into the introduction
of Bacterias
•Heart surgery
•Intubations Procedures involving gastrol intestinal
and genitourinaly tracts e.g. barium, enemas,
sigmoidoscopy, catheterisation and Cytoscopy
• Reproductive conditions like delivery of new
babies, abortions and pelvic inflammatory disease
The aortic valve with a large,
irregular, reddish tan vegetation
Here, infective endocarditis on the
mitral valve has spread into the septum
all the way to the tricuspid valve,
producing a fistula.
Microscopically, the valve in infective endocarditis demonstrates friable
vegetations of fibrin and platelets (pink) mixed with inflammatory cells and
bacterial colonies (blue). The friability explains how portions of the vegetation
can break off and embolize.
Here is a valve with infective endocarditis. The blue bacterial colonies on the lower
left are extending into the pink connective tissue of the valve. Valves are relatively
avascular, so high dose antibiotic therapy is needed to eradicate the infection.
Acute bacterial endocarditis caused by Staphylococcus aureus with perforation of
the aortic valve and aortic valve vegetations.
Acute bacterial endocarditis caused by Staphylococcus aureus with
aortic valve ring abscess extending into myocardium.
The small pink
vegetation on the
rightmost cusp
margin represents
the typical finding
with non-bacterial
thrombotic
endocarditis (or so-
called "marantic
endocarditis"). This
is non-infective. It
tends to occur in
persons with a
hypercoagulable
state (Trousseau's
syndrome, a
paraneoplastic
syndrome
associated with
malignancies) and in
very ill persons
Bartonella henselae bacilli in cardiac valve of a patient with blood culture-
negative endocarditis The bacilli appear as black granulations.
Clinical
Manifestations
Petechial rash. He was diagnosed with right-
sided staphylococcal endocarditis. Osler nodes
Osler's nodes on a finger and foot.
Janeway lesions are Flat, painless,
erythematous lesions seen on the palm
of this patient's hand. Frequently
associated with bacterial endocarditis.
Roth spots: red center with pale periphery; top
and left (The one on right is the optic disc, as it
has pale center and red periphery)
Seen here in the finger at the right are small splinter hemorrhages in a patient
with infective endocarditis. These hemorrhages are subungual, linear, dark red
streaks. Similar hemorrhages can also appear with trauma.
Libman-sacks
endocarditis.
Here are flat, pale
tan, spreading
vegetations over
the mitral valve
surface and even
on the chordae
tendineae.
INVESTIGATIONS
 Blood Examination.
 Blood culture
 ECG
Echocardiography: esp transesophageal
echocardiography.
 Immunoglobulins and compliment.
Urine exam: protein urea and microscopic hemeturia
is common
Complications of endocarditis and
indications for surgery
Up to 50% of patients will require surgery for IE. The
principal indications for this are:
• heart failure
 cardiogenic shock as a result of progressive native or
prosthetic valve obstruction/regurgitation or fistula
formation – emergency surgery (<24 hours)
 severe valve disease and symptoms of heart failure and a
poor haemodynamic response – urgent surgery (<7 days)
Cont.
• failure to control infection – urgent surgery
 local ongoing infection: aortic root abscess, aneurysm or
fistula formation, expanding vegetation size
 infection with a difficult to treat organism (fungi or
multiresistant organism, staphylococci or non-HACEK
Gram-negative bacilli on a prosthetic valve)
 persistence of positive blood cultures despite appropriate
antibiotics or inadequate control of metastatic septic foci
Cont.
• prevention of septic emboli – urgent surgery
vegetation >10 mm with an embolic event while
on appropriate antibiotic therapy
vegetation >30 mm
vegetation >10 mm and severe native or
prosthetic valve disease and patient is at a low
operative risk.
Non-HACEK gram-negative bacillus
endocarditis
Susan Morpeth et al.
Infective endocarditis caused by non-HACEK (species other than Haemophilus species,
Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella
corrodens, or Kingella species) gram-negative bacilli is rare, is poorly characterized, and
is commonly considered to be primarily a disease of injection drug users.
Objective: To describe the clinical characteristics and outcomes of patients with non-
HACEK gram-negative bacillus endocarditis in a large, international, contemporary cohort
of patients.
Design: Observations from the International Collaboration on Infective Endocarditis
Prospective Cohort Study (ICE-PCS) database.
Setting: 61 hospitals in 28 countries.
Cont.
Results: Among the 2761 case-patients with definite endocarditis enrolled in ICE-PCS,
49 (1.8%) had endocarditis (20 native valve, 29 prosthetic valve or device) due to non-
HACEK, gram-negative bacilli. Escherichia coli (14 patients [29%]) and Pseudomonas
aeruginosa (11 patients [22%]) were the most common pathogens. Most patients (57%)
with non-HACEK gram-negative bacillus endocarditis had health care-associated
infection, whereas injection drug use was rare (4%). Implanted endovascular devices
were frequently associated with non-HACEK gram-negative bacillus endocarditis
compared with other causes of endocarditis (29% vs. 11%; P < 0.001). The in-hospital
mortality rate of patients with endocarditis due to non-HACEK gram-negative bacilli was
high (24%) despite high rates of cardiac surgery (51%).
Nursing Diagnosis
• Acute pain related to systemic effects of infection.
• Risk for decreased cardiac output related to
disorders of the heart valves and the endothelium.
• Impaired body temperature related to the infection
process.
• Risk for Ineffective tissue perfusion related to
embolization.
THANK
YOU

More Related Content

Similar to Infective Endocarditis (IE) Lecture pptx

4_6030689835172236523.pptx
4_6030689835172236523.pptx4_6030689835172236523.pptx
4_6030689835172236523.pptxJibrilAliSe
 
IEPPT-IIIstd (2).pptx
IEPPT-IIIstd (2).pptxIEPPT-IIIstd (2).pptx
IEPPT-IIIstd (2).pptxyilkalmossie1
 
infective endocarditis c1.pptx Cardiovacsular system infection
infective endocarditis c1.pptx Cardiovacsular system infectioninfective endocarditis c1.pptx Cardiovacsular system infection
infective endocarditis c1.pptx Cardiovacsular system infectionAbdulkadirHasan
 
Endocarditis
EndocarditisEndocarditis
EndocarditisRafi Bhat
 
Infective endocarditis
Infective endocarditisInfective endocarditis
Infective endocarditisdrfarhatbashir
 
Infective endocarditis FINAL.pptx
Infective endocarditis FINAL.pptxInfective endocarditis FINAL.pptx
Infective endocarditis FINAL.pptxRashiSrivastava62
 
Infective endocarditis – an update
Infective endocarditis – an update Infective endocarditis – an update
Infective endocarditis – an update Harshitha S
 
infective endocarditis- dental applications
infective endocarditis- dental applicationsinfective endocarditis- dental applications
infective endocarditis- dental applicationsSohail Mohammed
 
infectiveendocarditis-july2015-190917173103.pdf
infectiveendocarditis-july2015-190917173103.pdfinfectiveendocarditis-july2015-190917173103.pdf
infectiveendocarditis-july2015-190917173103.pdfHaroonButt17
 
Infective endocarditis
Infective endocarditis Infective endocarditis
Infective endocarditis ikramdr01
 
Infective Endocarditis & Noninfected vagetation presentation
Infective Endocarditis & Noninfected vagetation presentation Infective Endocarditis & Noninfected vagetation presentation
Infective Endocarditis & Noninfected vagetation presentation Tahir Ramzan
 
Infective endocarditis
Infective endocarditisInfective endocarditis
Infective endocarditisAzad Haleem
 
Infective endocarditis european guidlines 2012
Infective endocarditis european guidlines 2012Infective endocarditis european guidlines 2012
Infective endocarditis european guidlines 2012Basem Enany
 
INFECTIVE ENDOCARDITIS.pptx
INFECTIVE ENDOCARDITIS.pptxINFECTIVE ENDOCARDITIS.pptx
INFECTIVE ENDOCARDITIS.pptxBadarJamal4
 

Similar to Infective Endocarditis (IE) Lecture pptx (20)

4_6030689835172236523.pptx
4_6030689835172236523.pptx4_6030689835172236523.pptx
4_6030689835172236523.pptx
 
Infective endocarditis
Infective endocarditis Infective endocarditis
Infective endocarditis
 
IEPPT-IIIstd (2).pptx
IEPPT-IIIstd (2).pptxIEPPT-IIIstd (2).pptx
IEPPT-IIIstd (2).pptx
 
infective endocarditis c1.pptx Cardiovacsular system infection
infective endocarditis c1.pptx Cardiovacsular system infectioninfective endocarditis c1.pptx Cardiovacsular system infection
infective endocarditis c1.pptx Cardiovacsular system infection
 
Infective endocarditis
Infective endocarditisInfective endocarditis
Infective endocarditis
 
Endocarditis
EndocarditisEndocarditis
Endocarditis
 
Infective endocarditis
Infective endocarditisInfective endocarditis
Infective endocarditis
 
Infective endocarditis FINAL.pptx
Infective endocarditis FINAL.pptxInfective endocarditis FINAL.pptx
Infective endocarditis FINAL.pptx
 
Infective endocarditis – an update
Infective endocarditis – an update Infective endocarditis – an update
Infective endocarditis – an update
 
Endocarditis
EndocarditisEndocarditis
Endocarditis
 
infective endocarditis- dental applications
infective endocarditis- dental applicationsinfective endocarditis- dental applications
infective endocarditis- dental applications
 
infectiveendocarditis-july2015-190917173103.pdf
infectiveendocarditis-july2015-190917173103.pdfinfectiveendocarditis-july2015-190917173103.pdf
infectiveendocarditis-july2015-190917173103.pdf
 
Infective endocarditis
Infective endocarditis Infective endocarditis
Infective endocarditis
 
Infective Endocarditis & Noninfected vagetation presentation
Infective Endocarditis & Noninfected vagetation presentation Infective Endocarditis & Noninfected vagetation presentation
Infective Endocarditis & Noninfected vagetation presentation
 
Infective endocarditis
Infective endocarditisInfective endocarditis
Infective endocarditis
 
Infective endocarditis
Infective endocarditisInfective endocarditis
Infective endocarditis
 
Infective endocarditis european guidlines 2012
Infective endocarditis european guidlines 2012Infective endocarditis european guidlines 2012
Infective endocarditis european guidlines 2012
 
INFECTIVE ENDOCARDITIS.pptx
INFECTIVE ENDOCARDITIS.pptxINFECTIVE ENDOCARDITIS.pptx
INFECTIVE ENDOCARDITIS.pptx
 
7._Infective_Endocarditis.pptx
7._Infective_Endocarditis.pptx7._Infective_Endocarditis.pptx
7._Infective_Endocarditis.pptx
 
Infective Endocarditis
Infective EndocarditisInfective Endocarditis
Infective Endocarditis
 

More from Shashi Prakash

Gastrointestinal (GI) examination. Seminar ppt.
Gastrointestinal (GI) examination. Seminar  ppt.Gastrointestinal (GI) examination. Seminar  ppt.
Gastrointestinal (GI) examination. Seminar ppt.Shashi Prakash
 
Renal System Examination. Seminar pptx..
Renal System Examination. Seminar pptx..Renal System Examination. Seminar pptx..
Renal System Examination. Seminar pptx..Shashi Prakash
 
HISTORY OF DEVELOPMENT OF NSG. PROF..pptx
HISTORY OF DEVELOPMENT OF NSG. PROF..pptxHISTORY OF DEVELOPMENT OF NSG. PROF..pptx
HISTORY OF DEVELOPMENT OF NSG. PROF..pptxShashi Prakash
 
Viral hepatitis & Related Real Life Experience.pptx
Viral hepatitis & Related Real Life Experience.pptxViral hepatitis & Related Real Life Experience.pptx
Viral hepatitis & Related Real Life Experience.pptxShashi Prakash
 
Demonstration on Mechanical Ventilator.pptx
Demonstration on Mechanical Ventilator.pptxDemonstration on Mechanical Ventilator.pptx
Demonstration on Mechanical Ventilator.pptxShashi Prakash
 
Food Poisoning Lecture cum Discussion ppt
Food Poisoning Lecture cum Discussion pptFood Poisoning Lecture cum Discussion ppt
Food Poisoning Lecture cum Discussion pptShashi Prakash
 
Gannt Chart Class Presentation pptx
Gannt  Chart  Class  Presentation   pptxGannt  Chart  Class  Presentation   pptx
Gannt Chart Class Presentation pptxShashi Prakash
 
BETTY NEUMANN’S SYSTEM MODEL THEORY .pptx
BETTY NEUMANN’S SYSTEM MODEL THEORY .pptxBETTY NEUMANN’S SYSTEM MODEL THEORY .pptx
BETTY NEUMANN’S SYSTEM MODEL THEORY .pptxShashi Prakash
 
Topic: Gastritis Nursing Lecture ppt.ppt
Topic: Gastritis Nursing Lecture ppt.pptTopic: Gastritis Nursing Lecture ppt.ppt
Topic: Gastritis Nursing Lecture ppt.pptShashi Prakash
 
Upper GI bleeding (UGIB) Lecture Ppt.pptx
Upper GI bleeding (UGIB) Lecture Ppt.pptxUpper GI bleeding (UGIB) Lecture Ppt.pptx
Upper GI bleeding (UGIB) Lecture Ppt.pptxShashi Prakash
 
MANAGING CONFLICTS (Nursing Management)pptx
MANAGING CONFLICTS (Nursing Management)pptxMANAGING CONFLICTS (Nursing Management)pptx
MANAGING CONFLICTS (Nursing Management)pptxShashi Prakash
 
RUMINATION SYNDROME, BELCHING, AEROPHAGIA.pptx
RUMINATION SYNDROME, BELCHING, AEROPHAGIA.pptxRUMINATION SYNDROME, BELCHING, AEROPHAGIA.pptx
RUMINATION SYNDROME, BELCHING, AEROPHAGIA.pptxShashi Prakash
 
Anorectal Disorders - Gastroenterology pptx
Anorectal Disorders - Gastroenterology pptxAnorectal Disorders - Gastroenterology pptx
Anorectal Disorders - Gastroenterology pptxShashi Prakash
 
Injuries to bowel and mesentery. Lecture pptx
Injuries to bowel and mesentery.  Lecture pptxInjuries to bowel and mesentery.  Lecture pptx
Injuries to bowel and mesentery. Lecture pptxShashi Prakash
 
Hirschprung's Disease (HD) Lecture.pptx
Hirschprung's  Disease (HD) Lecture.pptxHirschprung's  Disease (HD) Lecture.pptx
Hirschprung's Disease (HD) Lecture.pptxShashi Prakash
 
Pott's Spine. (Tuberculosis Spine) pptx
Pott's Spine.  (Tuberculosis Spine) pptxPott's Spine.  (Tuberculosis Spine) pptx
Pott's Spine. (Tuberculosis Spine) pptxShashi Prakash
 

More from Shashi Prakash (16)

Gastrointestinal (GI) examination. Seminar ppt.
Gastrointestinal (GI) examination. Seminar  ppt.Gastrointestinal (GI) examination. Seminar  ppt.
Gastrointestinal (GI) examination. Seminar ppt.
 
Renal System Examination. Seminar pptx..
Renal System Examination. Seminar pptx..Renal System Examination. Seminar pptx..
Renal System Examination. Seminar pptx..
 
HISTORY OF DEVELOPMENT OF NSG. PROF..pptx
HISTORY OF DEVELOPMENT OF NSG. PROF..pptxHISTORY OF DEVELOPMENT OF NSG. PROF..pptx
HISTORY OF DEVELOPMENT OF NSG. PROF..pptx
 
Viral hepatitis & Related Real Life Experience.pptx
Viral hepatitis & Related Real Life Experience.pptxViral hepatitis & Related Real Life Experience.pptx
Viral hepatitis & Related Real Life Experience.pptx
 
Demonstration on Mechanical Ventilator.pptx
Demonstration on Mechanical Ventilator.pptxDemonstration on Mechanical Ventilator.pptx
Demonstration on Mechanical Ventilator.pptx
 
Food Poisoning Lecture cum Discussion ppt
Food Poisoning Lecture cum Discussion pptFood Poisoning Lecture cum Discussion ppt
Food Poisoning Lecture cum Discussion ppt
 
Gannt Chart Class Presentation pptx
Gannt  Chart  Class  Presentation   pptxGannt  Chart  Class  Presentation   pptx
Gannt Chart Class Presentation pptx
 
BETTY NEUMANN’S SYSTEM MODEL THEORY .pptx
BETTY NEUMANN’S SYSTEM MODEL THEORY .pptxBETTY NEUMANN’S SYSTEM MODEL THEORY .pptx
BETTY NEUMANN’S SYSTEM MODEL THEORY .pptx
 
Topic: Gastritis Nursing Lecture ppt.ppt
Topic: Gastritis Nursing Lecture ppt.pptTopic: Gastritis Nursing Lecture ppt.ppt
Topic: Gastritis Nursing Lecture ppt.ppt
 
Upper GI bleeding (UGIB) Lecture Ppt.pptx
Upper GI bleeding (UGIB) Lecture Ppt.pptxUpper GI bleeding (UGIB) Lecture Ppt.pptx
Upper GI bleeding (UGIB) Lecture Ppt.pptx
 
MANAGING CONFLICTS (Nursing Management)pptx
MANAGING CONFLICTS (Nursing Management)pptxMANAGING CONFLICTS (Nursing Management)pptx
MANAGING CONFLICTS (Nursing Management)pptx
 
RUMINATION SYNDROME, BELCHING, AEROPHAGIA.pptx
RUMINATION SYNDROME, BELCHING, AEROPHAGIA.pptxRUMINATION SYNDROME, BELCHING, AEROPHAGIA.pptx
RUMINATION SYNDROME, BELCHING, AEROPHAGIA.pptx
 
Anorectal Disorders - Gastroenterology pptx
Anorectal Disorders - Gastroenterology pptxAnorectal Disorders - Gastroenterology pptx
Anorectal Disorders - Gastroenterology pptx
 
Injuries to bowel and mesentery. Lecture pptx
Injuries to bowel and mesentery.  Lecture pptxInjuries to bowel and mesentery.  Lecture pptx
Injuries to bowel and mesentery. Lecture pptx
 
Hirschprung's Disease (HD) Lecture.pptx
Hirschprung's  Disease (HD) Lecture.pptxHirschprung's  Disease (HD) Lecture.pptx
Hirschprung's Disease (HD) Lecture.pptx
 
Pott's Spine. (Tuberculosis Spine) pptx
Pott's Spine.  (Tuberculosis Spine) pptxPott's Spine.  (Tuberculosis Spine) pptx
Pott's Spine. (Tuberculosis Spine) pptx
 

Recently uploaded

The next social challenge to public health: the information environment.pptx
The next social challenge to public health:  the information environment.pptxThe next social challenge to public health:  the information environment.pptx
The next social challenge to public health: the information environment.pptxTina Purnat
 
Music Therapy's Impact in Palliative Care| IAPCON2024| Dr. Tara Rajendran
Music Therapy's Impact in Palliative Care| IAPCON2024| Dr. Tara RajendranMusic Therapy's Impact in Palliative Care| IAPCON2024| Dr. Tara Rajendran
Music Therapy's Impact in Palliative Care| IAPCON2024| Dr. Tara RajendranTara Rajendran
 
SWD (Short wave diathermy)- Physiotherapy.ppt
SWD (Short wave diathermy)- Physiotherapy.pptSWD (Short wave diathermy)- Physiotherapy.ppt
SWD (Short wave diathermy)- Physiotherapy.pptMumux Mirani
 
Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...
Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...
Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...Wessex Health Partners
 
PULMONARY EMBOLISM AND ITS MANAGEMENTS.pdf
PULMONARY EMBOLISM AND ITS MANAGEMENTS.pdfPULMONARY EMBOLISM AND ITS MANAGEMENTS.pdf
PULMONARY EMBOLISM AND ITS MANAGEMENTS.pdfDolisha Warbi
 
Presentation on General Anesthetics pdf.
Presentation on General Anesthetics pdf.Presentation on General Anesthetics pdf.
Presentation on General Anesthetics pdf.Prerana Jadhav
 
Measurement of Radiation and Dosimetric Procedure.pptx
Measurement of Radiation and Dosimetric Procedure.pptxMeasurement of Radiation and Dosimetric Procedure.pptx
Measurement of Radiation and Dosimetric Procedure.pptxDr. Dheeraj Kumar
 
Presentació "Real-Life VR Integration for Mild Cognitive Impairment Rehabilit...
Presentació "Real-Life VR Integration for Mild Cognitive Impairment Rehabilit...Presentació "Real-Life VR Integration for Mild Cognitive Impairment Rehabilit...
Presentació "Real-Life VR Integration for Mild Cognitive Impairment Rehabilit...Badalona Serveis Assistencials
 
Radiation Dosimetry Parameters and Isodose Curves.pptx
Radiation Dosimetry Parameters and Isodose Curves.pptxRadiation Dosimetry Parameters and Isodose Curves.pptx
Radiation Dosimetry Parameters and Isodose Curves.pptxDr. Dheeraj Kumar
 
History and Development of Pharmacovigilence.pdf
History and Development of Pharmacovigilence.pdfHistory and Development of Pharmacovigilence.pdf
History and Development of Pharmacovigilence.pdfSasikiranMarri
 
Statistical modeling in pharmaceutical research and development.
Statistical modeling in pharmaceutical research and development.Statistical modeling in pharmaceutical research and development.
Statistical modeling in pharmaceutical research and development.ANJALI
 
call girls in green park DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in green park  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in green park  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in green park DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️saminamagar
 
Hematology and Immunology - Leukocytes Functions
Hematology and Immunology - Leukocytes FunctionsHematology and Immunology - Leukocytes Functions
Hematology and Immunology - Leukocytes FunctionsMedicoseAcademics
 
METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaur
METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaurMETHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaur
METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaurNavdeep Kaur
 
Presentation on Parasympathetic Nervous System
Presentation on Parasympathetic Nervous SystemPresentation on Parasympathetic Nervous System
Presentation on Parasympathetic Nervous SystemPrerana Jadhav
 
Introduction to Sports Injuries by- Dr. Anjali Rai
Introduction to Sports Injuries by- Dr. Anjali RaiIntroduction to Sports Injuries by- Dr. Anjali Rai
Introduction to Sports Injuries by- Dr. Anjali RaiGoogle
 
97111 47426 Call Girls In Delhi MUNIRKAA
97111 47426 Call Girls In Delhi MUNIRKAA97111 47426 Call Girls In Delhi MUNIRKAA
97111 47426 Call Girls In Delhi MUNIRKAAjennyeacort
 
Glomerular Filtration rate and its determinants.pptx
Glomerular Filtration rate and its determinants.pptxGlomerular Filtration rate and its determinants.pptx
Glomerular Filtration rate and its determinants.pptxDr.Nusrat Tariq
 
Case Report Peripartum Cardiomyopathy.pptx
Case Report Peripartum Cardiomyopathy.pptxCase Report Peripartum Cardiomyopathy.pptx
Case Report Peripartum Cardiomyopathy.pptxNiranjan Chavan
 
Culture and Health Disorders Social change.pptx
Culture and Health Disorders Social change.pptxCulture and Health Disorders Social change.pptx
Culture and Health Disorders Social change.pptxDr. Dheeraj Kumar
 

Recently uploaded (20)

The next social challenge to public health: the information environment.pptx
The next social challenge to public health:  the information environment.pptxThe next social challenge to public health:  the information environment.pptx
The next social challenge to public health: the information environment.pptx
 
Music Therapy's Impact in Palliative Care| IAPCON2024| Dr. Tara Rajendran
Music Therapy's Impact in Palliative Care| IAPCON2024| Dr. Tara RajendranMusic Therapy's Impact in Palliative Care| IAPCON2024| Dr. Tara Rajendran
Music Therapy's Impact in Palliative Care| IAPCON2024| Dr. Tara Rajendran
 
SWD (Short wave diathermy)- Physiotherapy.ppt
SWD (Short wave diathermy)- Physiotherapy.pptSWD (Short wave diathermy)- Physiotherapy.ppt
SWD (Short wave diathermy)- Physiotherapy.ppt
 
Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...
Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...
Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...
 
PULMONARY EMBOLISM AND ITS MANAGEMENTS.pdf
PULMONARY EMBOLISM AND ITS MANAGEMENTS.pdfPULMONARY EMBOLISM AND ITS MANAGEMENTS.pdf
PULMONARY EMBOLISM AND ITS MANAGEMENTS.pdf
 
Presentation on General Anesthetics pdf.
Presentation on General Anesthetics pdf.Presentation on General Anesthetics pdf.
Presentation on General Anesthetics pdf.
 
Measurement of Radiation and Dosimetric Procedure.pptx
Measurement of Radiation and Dosimetric Procedure.pptxMeasurement of Radiation and Dosimetric Procedure.pptx
Measurement of Radiation and Dosimetric Procedure.pptx
 
Presentació "Real-Life VR Integration for Mild Cognitive Impairment Rehabilit...
Presentació "Real-Life VR Integration for Mild Cognitive Impairment Rehabilit...Presentació "Real-Life VR Integration for Mild Cognitive Impairment Rehabilit...
Presentació "Real-Life VR Integration for Mild Cognitive Impairment Rehabilit...
 
Radiation Dosimetry Parameters and Isodose Curves.pptx
Radiation Dosimetry Parameters and Isodose Curves.pptxRadiation Dosimetry Parameters and Isodose Curves.pptx
Radiation Dosimetry Parameters and Isodose Curves.pptx
 
History and Development of Pharmacovigilence.pdf
History and Development of Pharmacovigilence.pdfHistory and Development of Pharmacovigilence.pdf
History and Development of Pharmacovigilence.pdf
 
Statistical modeling in pharmaceutical research and development.
Statistical modeling in pharmaceutical research and development.Statistical modeling in pharmaceutical research and development.
Statistical modeling in pharmaceutical research and development.
 
call girls in green park DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in green park  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in green park  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in green park DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
 
Hematology and Immunology - Leukocytes Functions
Hematology and Immunology - Leukocytes FunctionsHematology and Immunology - Leukocytes Functions
Hematology and Immunology - Leukocytes Functions
 
METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaur
METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaurMETHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaur
METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaur
 
Presentation on Parasympathetic Nervous System
Presentation on Parasympathetic Nervous SystemPresentation on Parasympathetic Nervous System
Presentation on Parasympathetic Nervous System
 
Introduction to Sports Injuries by- Dr. Anjali Rai
Introduction to Sports Injuries by- Dr. Anjali RaiIntroduction to Sports Injuries by- Dr. Anjali Rai
Introduction to Sports Injuries by- Dr. Anjali Rai
 
97111 47426 Call Girls In Delhi MUNIRKAA
97111 47426 Call Girls In Delhi MUNIRKAA97111 47426 Call Girls In Delhi MUNIRKAA
97111 47426 Call Girls In Delhi MUNIRKAA
 
Glomerular Filtration rate and its determinants.pptx
Glomerular Filtration rate and its determinants.pptxGlomerular Filtration rate and its determinants.pptx
Glomerular Filtration rate and its determinants.pptx
 
Case Report Peripartum Cardiomyopathy.pptx
Case Report Peripartum Cardiomyopathy.pptxCase Report Peripartum Cardiomyopathy.pptx
Case Report Peripartum Cardiomyopathy.pptx
 
Culture and Health Disorders Social change.pptx
Culture and Health Disorders Social change.pptxCulture and Health Disorders Social change.pptx
Culture and Health Disorders Social change.pptx
 

Infective Endocarditis (IE) Lecture pptx

  • 2.
  • 3. • Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves (native or prosthetic valves). Other structures which may be involved include the interventricular septum, the chordae tendinae, the mural endocardium, or even on intracardiac devices.
  • 5. • Infectious endocarditis involves the heart valves. • Sources of the infection may be transient bacteremia, which is common during dental, upper respiratory, urologic, and lower gastrointestinal diagnostic and surgical procedures. • The infection can cause growths on the heart valves, the lining of the heart, or the lining of the blood vessels. These growths may be dislodged and send clots to the brain, lungs, kidneys, or spleen.
  • 6. Pathophysiology • Is occur typically at sites of prexisting endocardial damage. However ,infection in previously normal heart occur by S. aureus. • Infection tend to occur at site of endothelial damage because these area attract deposit of platelets and fibrin, which are vulnerable to colonisation by blood born organisms. • Adjacent tissue are destroyed and abscess may form, valve regurgitation may develop or increased.
  • 7. • If the affected valve is damage by tissue distortion. •Extra cardiac manifestations e.g. vacuities, infarcts of skin, spleen ,kidney and brain due to emboli or immune complex deposits.
  • 8. CLASSIFICATION • Sub-acute bacterial endocarditis • Acute bacterial endocarditis • Post operative endocarditis
  • 9. Subacute bacterial endocarditis (SBE) • Although aggressive, usually develops insidiously and progresses slowly (i.e, over weeks to months). • Often, no source of infection or portal of entry is evident. • SBE is caused most commonly by streptococci (especially viridans, microaerophilic, anaerobic, and nonenterococcal group D streptococci and enterococci) and less commonly by S. aureus, Staphylococcus epidermidis • SBE often develops on abnormal valves after asymptomatic bacteremia due to periodontal, GI, or GU infections.
  • 10. Acute bacterial endocarditis (ABE) •Usually develops abruptly and progresses rapidly (i.e., over days). •A source of infection or portal of entry is often evident. When bacteria are virulent or bacterial exposure is massive, ABE can affect normal valves. •It is usually caused by S. aureus, group A hemolytic streptococci, pneumococci, or gonococci.
  • 11. Post operative or PVE endocarditis: •Develops in 2 to 3% of patients within 1 yr after valve replacement and in 0.5%/yr thereafter. •It is more common after aortic than after mitral valve replacement and affects mechanical and bioprosthetic valves equally.
  • 12. Causes •Fungus e.g. candida, aspagellus •Gram negative organisms e.g. pseudomonas •Bacteria's e.g. staphylococci •Acute rheumatic fever which cause enlarged and tender lymph nodes, damages the valves •Congenital heart disease
  • 13. Risk Factors •Previous heart damage •Dental procedures which lead into the introduction of Bacterias •Heart surgery •Intubations Procedures involving gastrol intestinal and genitourinaly tracts e.g. barium, enemas, sigmoidoscopy, catheterisation and Cytoscopy • Reproductive conditions like delivery of new babies, abortions and pelvic inflammatory disease
  • 14. The aortic valve with a large, irregular, reddish tan vegetation Here, infective endocarditis on the mitral valve has spread into the septum all the way to the tricuspid valve, producing a fistula.
  • 15. Microscopically, the valve in infective endocarditis demonstrates friable vegetations of fibrin and platelets (pink) mixed with inflammatory cells and bacterial colonies (blue). The friability explains how portions of the vegetation can break off and embolize.
  • 16. Here is a valve with infective endocarditis. The blue bacterial colonies on the lower left are extending into the pink connective tissue of the valve. Valves are relatively avascular, so high dose antibiotic therapy is needed to eradicate the infection.
  • 17. Acute bacterial endocarditis caused by Staphylococcus aureus with perforation of the aortic valve and aortic valve vegetations.
  • 18. Acute bacterial endocarditis caused by Staphylococcus aureus with aortic valve ring abscess extending into myocardium.
  • 19.
  • 20. The small pink vegetation on the rightmost cusp margin represents the typical finding with non-bacterial thrombotic endocarditis (or so- called "marantic endocarditis"). This is non-infective. It tends to occur in persons with a hypercoagulable state (Trousseau's syndrome, a paraneoplastic syndrome associated with malignancies) and in very ill persons
  • 21. Bartonella henselae bacilli in cardiac valve of a patient with blood culture- negative endocarditis The bacilli appear as black granulations.
  • 23.
  • 24. Petechial rash. He was diagnosed with right- sided staphylococcal endocarditis. Osler nodes
  • 25. Osler's nodes on a finger and foot. Janeway lesions are Flat, painless, erythematous lesions seen on the palm of this patient's hand. Frequently associated with bacterial endocarditis.
  • 26. Roth spots: red center with pale periphery; top and left (The one on right is the optic disc, as it has pale center and red periphery)
  • 27. Seen here in the finger at the right are small splinter hemorrhages in a patient with infective endocarditis. These hemorrhages are subungual, linear, dark red streaks. Similar hemorrhages can also appear with trauma.
  • 28. Libman-sacks endocarditis. Here are flat, pale tan, spreading vegetations over the mitral valve surface and even on the chordae tendineae.
  • 29.
  • 30. INVESTIGATIONS  Blood Examination.  Blood culture  ECG Echocardiography: esp transesophageal echocardiography.  Immunoglobulins and compliment. Urine exam: protein urea and microscopic hemeturia is common
  • 31.
  • 32.
  • 33. Complications of endocarditis and indications for surgery Up to 50% of patients will require surgery for IE. The principal indications for this are: • heart failure  cardiogenic shock as a result of progressive native or prosthetic valve obstruction/regurgitation or fistula formation – emergency surgery (<24 hours)  severe valve disease and symptoms of heart failure and a poor haemodynamic response – urgent surgery (<7 days)
  • 34. Cont. • failure to control infection – urgent surgery  local ongoing infection: aortic root abscess, aneurysm or fistula formation, expanding vegetation size  infection with a difficult to treat organism (fungi or multiresistant organism, staphylococci or non-HACEK Gram-negative bacilli on a prosthetic valve)  persistence of positive blood cultures despite appropriate antibiotics or inadequate control of metastatic septic foci
  • 35. Cont. • prevention of septic emboli – urgent surgery vegetation >10 mm with an embolic event while on appropriate antibiotic therapy vegetation >30 mm vegetation >10 mm and severe native or prosthetic valve disease and patient is at a low operative risk.
  • 36. Non-HACEK gram-negative bacillus endocarditis Susan Morpeth et al. Infective endocarditis caused by non-HACEK (species other than Haemophilus species, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, or Kingella species) gram-negative bacilli is rare, is poorly characterized, and is commonly considered to be primarily a disease of injection drug users. Objective: To describe the clinical characteristics and outcomes of patients with non- HACEK gram-negative bacillus endocarditis in a large, international, contemporary cohort of patients. Design: Observations from the International Collaboration on Infective Endocarditis Prospective Cohort Study (ICE-PCS) database. Setting: 61 hospitals in 28 countries.
  • 37. Cont. Results: Among the 2761 case-patients with definite endocarditis enrolled in ICE-PCS, 49 (1.8%) had endocarditis (20 native valve, 29 prosthetic valve or device) due to non- HACEK, gram-negative bacilli. Escherichia coli (14 patients [29%]) and Pseudomonas aeruginosa (11 patients [22%]) were the most common pathogens. Most patients (57%) with non-HACEK gram-negative bacillus endocarditis had health care-associated infection, whereas injection drug use was rare (4%). Implanted endovascular devices were frequently associated with non-HACEK gram-negative bacillus endocarditis compared with other causes of endocarditis (29% vs. 11%; P < 0.001). The in-hospital mortality rate of patients with endocarditis due to non-HACEK gram-negative bacilli was high (24%) despite high rates of cardiac surgery (51%).
  • 38. Nursing Diagnosis • Acute pain related to systemic effects of infection. • Risk for decreased cardiac output related to disorders of the heart valves and the endothelium. • Impaired body temperature related to the infection process. • Risk for Ineffective tissue perfusion related to embolization.