Endocarditis

Presented By:
Prabhdeep Kaur
M.Sc. (N) 1st year
 INTRODUCTION
• Three layers are (Endocardium, Myocardium,
Pericardium) covering the heart.
• Infectious process can occur in any of these
layers.
1. Endocarditis (Endocardium)
2. Myocarditis (Myocardium)
3. Pericarditis (Pericardium)
 DEFINITION
• Endocarditis is a microbial infection of
endothelial surface of heart.
• It is a serious infection, that is associated
with high degree of illness and death.
 ETIOLOGY

• Staphylococcus aureus
• Viridans streptococcus
• Enterococci
• Streptococci bovis
• Fungi – e.g. Candida,
aspagallus
 PATHOPHYSIOLOGY
Due to etiological agents

Infectious organisms invade the clot and endocardial

lesions

Results in platelets, fibrin, blood cells and

microorganisms activation

Forms clusters on endocardium

 PATHOPHYSIOLOGY Contd…

Clot on endocardium continues to expand

Infection may erode through endocardium to

other underlying structures (valve leaflets)

Causes tear or other deformities of valve

leaflets.
 SIGNS OF
ENDOCARDITI
S
 SIGNS AND SYMPTOMS

• Fever
• Heart murmurs
• Petechiae
• Tachycardia
• Extreme fatigue
• Malaise
• Chest pain and breathing difficulty
DIAGNOSTIC TESTS
 DIAGNOSTIC TESTS

Duke’s Criteria for Infective

Endocarditis
Mnemonic - BE FIVER
 DIAGNOSTIC Criteria

Major Criteria

• B – Blood culture positive (Two tests

positive for typical microorganisms)
• E – Echocardiogram shows:
o Valve regurgitation
o Abscess
 DIAGNOSTIC CRITERIA
Minor Criteria
• F – Fever >38℃
• I – Immunological phenomena
(Roth spots, Osler nodes, Glomerulonephritis)
• V – Vascular phenomena (intra arterial emboli/
Janeway Lesions or conjuctivital hemorrhage)
• E – Echocardiogram/ Blood cultures
• R – Risk factors (IV drug abusers)
 DIAGNOSTIC TESTS

• DEFINITE INFECTIVE ENDOCARDITIS:

2 major OR 1 major + 3 minor criteria

• POSSIBLE INFECTIVE ENDOCARDITIS:

1 major + 1 minor OR 3 minor criteria
 BLOOD TESTS

 ESR
 CRP
 TROPONIN LEVELS
 CBC
 UREA & CREATININE
 BLOOD CULTURE
 MANAGEMENT

 Antibiotic therapy: 2-6 weeks every four

hours or continuously by IV infusion or once
daily by intramuscular injection.
• Vancomycin 500-1000 mg, IV
• Gentamicin – 5-7 mg/kg body weight,
IV/IM
• Cefepime – 500 – 1000mg, IV
 MANAGEMENT

Antifungal therapy: In case of fungal infection

Amphotericin B - 0.25mg / kg body weight
SURGICAL MANAGEMENT
 SURGICAL MANAGEMENT

 Surgical interventions include:

1. Valve debridement/ excision
2. Debridement of vegetation
3. Debridement or closure of an abscess
4. Aortic or mitral valve debridement/
excision/ replacement
VALVE DEBRIDEMENT
Nursing management
 NURSING MANAGEMENT

 History & physical examination.

 Assess fever of the patient.
 Rest period should be planned.
 Infection control and good hand
hygiene is necessary by both
patient and care givers.
 BIBLIOGRAPHY
1) Brunner & Suddarth. Textbook of Medical Surgical
Nursing. Volume 1. 13th edition. New delhi. Wolter
Kluwer Publishers. Page no. 458 to 463
2) Black Joyce M. Medical Surgical Nursing Clinical
Management of positive outcome. 8th ed. New Delhi:
Mosby Elsevier Publishers; 2009. Page no. 348-359
3) Heitkemper, O’Brien and Chintamani. Lewis’s Medical
Surgical Nursing Assessment and Management of Clinical
Problems. New Delhi: Mosby Elsevier Publishers; 2011.
Page no. 1234-1236
 ASSIGNMENT

Prepare a Nursing Care Plan

on endocarditis.