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Endocarditis
Chapter 37
Question | Answer |
---|---|
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 |