Endocarditis usually occurs when germs from elsewhere in the body travel through the blood and attach to damaged areas of the heart. People with damaged or artificial heart valves or other heart conditions are most at risk.

1. By,
Ved prakash panda
M.Pharm (pharmacology)

2.  Introduction.
 Risk factors.
 Types of endocarditis.
 Symptoms and Diagnosis.
 Infective endocarditis.
 Treatment.

3.  Endocarditis is the inflammation of heart’s
inner layer i.e. endocardium.
 Endo- inner layer, Card- heart, Itis- inflammation.
 Heart layers are of three types i) Epicardium
ii) Myocardium
iii) Endocardium
 Mostly endocarditis is due to microbial infection
which is due to open wound , dental or surgical
issues, infected needle or substances.
 Microbes usually enters the bloodstream then it
goes to the endocardium of the heart specifically
acting on the valves (Mitral and Aortic) on the left
side of the heart and rarely on the right side heart
valve.

5.  Endothelial lining of the valve gets damaged due
to the inflammation or injury thereby exposing
the underlying collagen and tissue factor.
 The platelets and fibrin released due to the
injury to the cell/tissue tend to form blood clots
(thrombosis).
 In infective cases the bacteria comes and
adheres to the valve tissue where the thrombosis
has occurred via adhesin that helps in
attachment to the surface of it.
 The bacteria forms a cluster via same adhesion
mechanism and this cluster continues to grow .
 They form a layer to protect themselves from
the blood flow by releasing or surrounding
themselves with a chemical layer called
‘biofilm’.

7. Prosthetic valves.
Congenital heart defects
involving the valve.
Rheumatic heart disease.
Intravenous drug abuse.
 Intravenous drug abuse leads to damage of
the valve (Tricuspid valve) on the right side
of the heart.

8. Endocarditis is of two types i.e.
a) Non-bacterial thrombotic endocarditis
(NBTE).
b) Infective endocarditis.
 Non-bacterial thrombotic endocarditis is
the type where it occurs prior to the bacterial
infection due to some biological or non biological
issues .
 The Libman Sacks Endocarditis is a NBTE .
* it is associated with systemic lupus
erythematous which is an autoimmune disease.
 Antigen-antibody complex effects the
endocardium i.e. * valve surface(matrial valve).
* cordae tendinea.

9. SYMPTOMS
 High Fever.
 New heart murmur (turbulent flow of
blood due to passively damaged heart
valve).
DIAGNOSIS
 Positive blood culture (grow bacteria from
blood sample).
 Echocardiology (visualize heart movement
of the valve).

10.  Infective endocarditis occurs due to the
microbial accumulation at the valve of
the heart which leads to infection thus
damaging the valve tissue leading to the
disease.
 It is generally classified on the basis of
‘how fast it developed’ i.e.
* Acute.
* Sub-acute.
 Recent approach is based on the
‘identification of the microbial cause’.

11.  Most common bacterial infections are caused
by, * Viridans Streptococci.
* Staphylococcus aureus.
* Staphylococcus epidermis.
* Enterococcus faecalis.
* Coxiella burnetii.
 Hacek Organisms
• These are the Gram negative bacteria.
• Normal flora is in Mouth/throat.

12.  Prolonged Antibiotics (To wipe out infection).
* I.v injections of Vancomycin and rephacin.
 Surgery.
* In severe cases where valve dysfunction
occurs leading to hearty failure.

13.  Rang & Dale’s pharmacology
 Essential of medical pharmacology, K D
Tripathi.
 www.Google.com