Download Infective Endocarditis

Infective Endocarditis
Karen Duncan
Senior Adult Congenital Heart Liaison Nurse RGN, MSc
East Midlands Congenital Heart Centre
Glenfield Hospital
Leicester
What is it?
• Infection of the endothelial surface of the
heart by a micro-organism
• Uncommon but life threatening
• High morbidity and mortality
What causes it?
• Turbulent blood flow can damage the
smooth surface
• Platelets/fibrin/leucocytes
• Vegetation
The facts
• 2,150 cases in the UK every year
• Incidence is rising
• 15-20% of patients die during their initial
hospital admission
• Further 10-15% die over the following
year
• 35-40% are caused by oral viridans
Streptococcus
• 35-40% are caused by skin related
Staphylococci
• 40-45% require surgery, often involving
prosthetic replacement of one or more
heart valves
• Further 10% need surgery within a year
Thornhill et al 2016
Risk Factors
Risk Factors
• Untreated infections ….. anywhere
• Poor oral hygiene
• Dental work requiring manipulation of the gum
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(potential for bleeding)
Cardiac valvular abnormalities
Previous endocarditis
Life style issues
Body Piercing
Tattoos
Presentation of Endocarditis
• This can be over the course of a
few days rapidly getting worse
(acute endocarditis)
• Slowly over the course of a few
weeks (subacute endocarditis)
Symptoms
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High temperature above 38 °C or above
Night sweats
Shortness of breath on exertion
Fatigue
Muscle and joint pain
Unexplained weight loss
Worsening heart murmur
Narrow red/brown streaks under the nails (Splinter
haemorrhages)
Spotty red rash on the skin (Petechiae)
Red tender lesions under the skin of the fingers or
toes (Oslers nodes)
Roth spots – retinal haemorrhage with small clear
centre
Confusion
Are there complications?
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Congestive cardiac failure
Emboli
Abscess
Stroke
Myocardial infarction
Cardiac arrhythmia
Infection in other parts of the body
Glomerulonephritis
Treatment
• To eradicate infectious agent from the
thrombus
• Address any complications of valvular
infection
• Intravenous
Antibiotics for at least
6 weeks
• Surgery for
debridement or valve
replacement
What should I do if I feel unwell?
Seek medical advice from ;
• cardiac liaison team
• GP
• Walk-in centre
• dial 111
• A&E
Antibiotic Prophylaxis – what’s new?
UK versus USA versus Europe
• NICE 2008
• AHA 2007
• ESC 2009
•Lancet 2015 Dayer et al
•NICE review 2015
Congenital Heart nurses role
• Bloods, CRP, WCC, Antibiotic levels, blood
cultures, MSU
• Arrange for PICC line insertion
• Arrange for Echo
• ANTT for patients and carers
• Review dressing and insertion site
• Referral to OPAT team / DN team
Take home messages
• Register with a dentist
• Attend the dentist twice yearly
• Find out whether you need antibiotic cover for
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dental interventions
Be aware of signs/symptoms of IE
Know where to seek medical advice
Attend your regular out patient review
Do not ignore persistent symptoms
Leaflets and warning cards
Thank you for listening
Any Questions?