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Chapter 37

Infection of the inner layer of the heart, including the cardiac valves. infective endocarditis (IE)
What kind of treatment for IE has improved the prognosis of this disease? antibiotic therapy
What is the innermost layer of the heart and heart valves? endocardium
IE can be classified into what two forms? acute or subacute
This form of IE affects those with preexisting valve disease and has clinical course that may extend over months. subacute form
This form of IE affects those with healthy valves and manifests as a rapidly progressive illness. acute form
How else can IE be classified? cause (e.g. IV drug abuse, fungal endocarditis) or site of involvement (e.g. prosthetic valve endocarditis - PVE)
What organisms cause IE? Staphylococcus aureus and Streptococcus viridans (bacterial) are most common; other possible pathogens include fungi and viruses.
How does IE occur? Occurs when blood turbulence within the heart allows the causative organism to infect previously damaged valves or other endothelial surfaces.
What are some risk factors for IE? Variety of cardiac, noncardiac conditions, those undergoing invasive procedures; rheumatic heart disease, age, IVDA, use of prosthetic valves, use of intravascular devices (result in HCAI), & renal dialysis.
What are the primary lesions of IE and what do they consist of? vegetations; consist of fibrin, leukocytes, platelets, and microbes that adhere to the valve surface or endocardium
What can result if parts of these fragile vegetations break off into the circulation? embolus
If a vegetation were to break off on the left side of the heart where could you have an embolism? anywhere in the body from various organs (e.g. brain, kidneys, spleen) and to the extremitites, causing limb infarction
If a vegetation were to break off on the right side of the heart where could you have an embolism? to the lungs resulting in a pulmonary embolus
What are some clinical manifestations of IE? low grade fever occurs in 90% of pts, chills, weakness, malaise, fatigue, anorexia
What are the clinical manifestations of the subacute form of IE? arthralgias, myalgias, back pain, abdominal discomfort, weight loss, headache, clubbing of fingers
What are the vascular manifestations of IE? splinter hemorrhages in nail beds (black longitudinal streaks), petechiae, Osler's nodes on fingers or toes, Janeway's lesions on palms or soles, Roth's spots
What are Osler's nodes? painful, tender, red or purple, pea-size lesions
What are Janeway's lesions? flat, painless, small, red spots
What are Roth's spots? hemorrhagic retinal lesions
Where can petechiae occur in IE? in the conjunctivae, lips, buccal mucosa and palate, and over the ankles, feet, and antecubital, popliteal areas
Created by: eblanc1