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Infective Endocarditis
By:
Katie Walton
Infective Endocarditis
• An infection in the endothelium (the innermost
lining of the heart).
• 2 to 4 people out of every 100,000 are infected
every year with endocarditis.
• It most frequently occurs in males over 50.
• Of people who are infected with endocarditis,
65 percent have been diagnosed with a
predisposing heart condition.
Signs and Symptoms
• It doesn’t present to be life threatening, but it is
very important to recognize.
• Develops rather slowly in many cases,
however, it may develop quickly.
• Speed of infection depends on the bacteria
which is causing the infection.
• Some early symptoms include: rash, headache,
fever, weight loss, backaches, anemia, fatigue,
night sweats, confusion, and joint pains.
Signs and Symptoms (Continued)
• As the infection advances, little dark lines,
referred to as splinter hemorrhages, appear
beneath the fingernails.
Signs and Symptoms (Continued)
• A more prominent symptom of this disease is a
heart murmur caused by irregular flow of blood
through flawed or damaged valves.
• The change of blood flow across the valves is
due to bundles of bacteria, fibrin and cellular
debris which accumulate on the valves of the
heart.
• The two most common valves affected during
heart murmurs are the mitral valve and the
aortic valve.
• The doctor also may detect an enlarged spleen
and mild anemia included in his findings.
Etiology
• The cause is usually transient bacteremia,
which is the existence of bacteria in the blood.
• This frequently occurs during dental, surgical,
upper respiratory, urologic, and lower
gastrointestinal procedures.
• The infection could cause build up on the heart
valves, lining of the heart, or the lining of the
blood vessels.
• If the build up were to be dislodged it could
send clots to the brain, lungs, kidneys, or
spleen.
Etiology (Continued)
• There are several different kinds of bacteria
which could be the root cause of endocarditis.
• An organism frequently found in the mouth
called Streptococcus viridans is accountable for
about half of all bacterial endocarditis.
• Further widespread organisms include
Staphylococcus and Group D Streptococcus.
• Studies have suggested that 60% to 80% of
patients with bacterial endocarditis will be
diagnosed with some form of predisposing
cardiovascular defect.
Etiology (Continued)
• Rheumatic heart disease is found in about 30%
of bacterial endocarditis cases.
• Congenital heart disease is found in
approximately 10% to 20% and mitral valve
prolapse in about 10% to 33% of cases.
• Reports verified an increased threat of bacterial
endocarditis among drug abusers.
• There is a 30% chance of developing
endocarditis within 2 years of becoming an
intravenous drug addict. This is due to the use
of non-sterile needles which permit bacteria to
flow directly into the bloodstream.
Pathogenesis
• Endocarditis takes place when bacteria enter
into the bloodstream.
• Bacteria are usually introduced into the
bloodstream through an infection found in
another branch of the body.
• This bacterium then contaminates damaged
endocardium or endothelial tissue, situated
close to high-flow shunts, between the arterial
and venous channels.
• Additional microorganisms including fungi and
viral infections, could infect these areas, but it is
rare.
Pathogenesis (Continued)
• Bacteria can also be forced into the
bloodstream in the event of a surgical
procedure, dental treatment, or even while
brushing your teeth.
• Many of the bacteria that invade the
bloodstream are destroyed by the immune
system.
• The ones that survive will bunch together on a
heart valve or a different segment of the
endocardium.
• Infection will occur shortly after and the immune
system is unable to clear it out.
Pathogenesis (Continued)
• Shortly after, little bunches of matter called
vegetations will build up on the infected valves.
• This vegetation includes bacteria, small blood
clots, and additional waste from the infection,
which might prevent the affected valves from
opening and closing properly.
• It is also possible for the infection to damage
these affected valves and move into additional
areas of the endocardium or heart tissue.
Prognosis
• The expected outcome depends on whether it
is detected before the heart function begins to
deteriorate.
• It can usually be cured if diagnosed and treated
by an early stage.
• In some cases, if detected soon enough it can
be treated with antibiotics.
• In other cases, however, the infection may be
too advanced and the heart could sustain
serious damage. The patient needs to get
treatment as soon as possible.
Prognosis (Continued)
• Patients may also die from serious
complications such as damaged heart valves
which lead to heart failure.
• A large piece of vegetation could also break off
and obstruct the current in a main artery
causing death.
• If an artery in the brain were to be obstructed it
could lead to a stroke or sudden failure of vision
in one eye.
• Patients who develop vegetation larger than 10
mm, have a greater chance of morbidity and
mortality than patients with minor vegetation.
Prognosis (Continued)
• Surveys have established an outcome of
patient recovery following successful therapy.
• Native valve vegetation which is resolved in
patients is 25% to 30%.
• Decrease in vegetation accumulation is 15% to
20%.
• Vegetation with unchanged accumulation is
35% to 40%.
• Increase in vegetation accumulation in patients
is 10% to 15%.
• Continual vegetation usually become fibrosed
and seldom calcified.
Prognosis (Continued)
• Patients who develop major valve dysfunction
have a 15% to 30% risk of dying in surgery and
50% to 70% chance of overall survival if they
live 1 to 2 years following surgery.
Diagnostic Tests & Treatment
• Endocarditis can be identified by recognizing
symptoms as mentioned earlier, particularly if
the patient has a predisposing condition.
• It is especially important to hospitalize patients
who are suspected of having endocarditis, and
provide treatment as needed.
• Diagnostic tests may consist of X-rays of the
heart and lungs, an echocardiogram, laboratory
blood counts and blood cultures, which are
tested for bacteria, or an ultrasound scan of the
heart (electrocardiogram).
Diagnostic Tests & Treatment
(Continued)
• Echocardiography and electrocardiograms are
the most reliable tests to diagnose infective
endocarditis.
• Echocardiography is used to see valve
structure and function, heart wall motion, and
overall heart size.
• Ultrasound (electrocardiograms) provide
reflected sound waves to produce a
representation of the heart.
• This allows the physician to spot any damage in
the heart valves or vegetation that has built up.
Diagnostic Tests & Treatment
(Continued)
• Medications called antibiotics, which kill the
microorganisms in your bloodstream and within
the vegetations, are the first line of treatment.
• Antibiotics may be given for as long as six
weeks to control the infection.
• If the vegetation has damaged the heart valves
surgery may be needed to repair or replace the
damaged valve.
Conclusion
• Infective endocarditis is a very serious heart
disease.
• It is important that people recognize and
understand the risks involved.
• Certain precautions can be taken in order to
prevent this disease.
• If you have any heart valve damage or a heart
murmur it is important that you request
antibiotics prior to any medical procedures that
may introduce bacteria into the blood.
Conclusion (Continued)
• This includes dental work, childbirth, and
surgery of the urinary or gastrointestinal tract.
• Don’t use illicit drugs such as heroin or cocaine.
• Consumption of alcohol should be in
moderation and remember to always maintain
good oral hygiene.
• Thank you are there any questions?
• References
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February 10, 2006 from http://health.allrefer.com/health/infectiveendocarditis-info.html
• Beckerman, James M.D. “Infective Endocarditis.” Personal MD
2000. Retrieved February 1, 2006 from
http://www.personalmd.com/news/inf_endo_041100.shtml
• Endocarditis. “Bacterial or Infective Endocarditis.” General Illness
Information 2004. Retrieved on February 10, 2006 from
http://www.rxmed.com/b.main/b1.illness/b1.1.illnesses/ENDOCARDI
TIS%20
• Little, James and Falace, Donald. 1997. Dental Management of the
Medically Compromised Patient. St. Louis, Missouri: Mosby, Inc.
• Patient UK. “Infective Endocarditis.” EMIS and PIP 2004.
Retrieved February 10, 2006 from
http://www.patient.co.uk/showdoc/27000162/
• Roldan, Carlos A. 2005. The Ultimate Echo Guide. Philadelphia:
Lippincott Williams & Wilkins.
• Texas Heart Institute. “Infective Endocarditis.” Heart Information
Center 2005. Retrieved February 1, 2006 from
http://www.tmc.edu/thi/endocard.html