Endocarditis

Question 1

What is endocarditis?

Answer 1

Inflammation of the endocardium and valves

Question 2

In a majority of cases, what is endocarditis cased by?

Answer 2

bacterial infection

Question 3

Endocardium?

Answer 3

Band of tissue adjacent to the chambers (innermost lining of the cardiac wall)

Question 4

For a bacterial infection to occur, what must the bacteria do?

Answer 4

• Find a way into circulation. (It is more difficult than entering the respiratory tract. Pt is often immunosuppressed in some way)
• Survive in the bloodstream and evade all the defense cells
• Adhere to a surface (The endocardium is smooth, the pressure within the chambers is high and blood flow is turbulent. Bacteria need a rougher surface to adhere to eg. sutures from surgery, defective valves)
• Once the bacteria have attached to the surface, the abnormality attracts platelets. There is no hemorrhage so the platelets are not needed. Their presence is disadvantageous as they create fibrin strands that bacteria colonize in.

Question 5

What are the manifestations of endocarditis?

Answer 5

• Local and systemic infection (presenting with fever, SOB, tired, pain in chest)
• cardiac murmur (abnormal heart sound)
• impaired valve function (infection is likely close to the valves)

Question 6

What is a complication that can occur from endocarditis?

Answer 6

Distal embolization (clot formation can break off due to turbulent blood flow and move through chambers and valves and out of the aorta, until it reaches a smaller vessel in the systemic circuit and blocks blood flow)

Question 7

What are the diagnostic tests taken for endocarditis?

Answer 7

It is difficult to make a diagnosis because of the location but the following can help:

• History (signs of infection)
• Blood culture - C&S to test the blood (which flows through the chambers of the heart where the infection is)
• Once a systemic infection is suspected, blood serology is performed to measure specific antibodies in the blood. (serology Is faster than C&S but not as accurate)
• Echocardiogram -> performed later to determine the location of the infection

Question 8

Treatment for endocarditis?

Answer 8

• Antibiotics (typically run for 10-14 days for cardiac problems)
• Symptomatic management -> deal with cardiac problems as they rise.