Endocarditis is an inflammation of the inner layer of the heart that usually involves the valves. It is caused by bacteria, fungi, or other microorganisms entering the bloodstream and accumulating on heart valves and structures. Risk factors include intravenous drug use, older age, invasive medical procedures, and congenital heart disease. Symptoms may include fever, heart murmurs, embolisms, and signs of valve damage depending on the affected area. Diagnosis involves blood cultures, echocardiogram, and physical exam. Treatment is generally antibiotics and sometimes surgery if valve damage is severe.

1. ENDOCARDITIS

2. INTRODUCTION
The heart is a vital organ that pumps blood and
it has three layers which are Endocardium,
Myocardium and Pericardium.

3. DEFINITION
1. Endocarditis is an inflammation of the inner layer
of the heart, the endocardium. it usually involves
the valves and other structures like the septum.
2. It is an infection of valves and endothelial surface
of the heart

4. ETIOLOGY
• Fungus- e.g. Candida, Aspergillus
• Gram Negative Organisms- e.g. Pseudomonas
• Bacteria- e.g. Staphylococci, Streptococci, Pneumococci
• Acute Rheumatic Fever
• Congenital Heart Disease

5. RISK FACTORS
• IV drug users --- Rt heart valve infections
• Older People --- low immunity
• Invasive Procedure involve mucosal surfaces
• Dental Procedures, Intubation, Bronchoscopy, Cystoscopy,
Colonoscopy, Catheterization, Surgery
• Prosthetic Heart Valves
• History of Bacterial Endocarditis

6. PATHOPHYSIOLOGY
Causative agents enter the blood stream
They accumulate on the valves of the heart or
endocardium
Form vegetations or Clusters
Vegetations causes damage to heart valves by
perforating and deforming the valves leaflets
Valvular Heart Disease

7. CLINICAL MANIFESTIONS
Onset is sudden
• Fever
• Dysrhythmias
• Heart Murmurs
• S/S of valvular heart disease depends on which valve is
affected

8. CLINICAL MANIFESTIONS
• Malaise
• Anorexia
• Weight loss
• Cough
• Splinter hemorrhage (reddish –brown line /streaks) under
fingernails & toenails

9. CLINICAL MANIFESTIONS
• Petechiae in Conjunctiva and Mucus Membrane
• Osler’s nodes - Small, painful nodule in pads of
fingers and toes
• Janeway Lesion- Irregular red painless flat macule
• Roth’s spot - Hemorrhage with pale center in
fundus of eye due to emboli in nerve fiber of eye
• CVS: Cardiac Murmur, Cardiomegaly
• CNS: Headache, Transient Cerebral Ischemia,
Strokes due to emboli in cerebral arteries

10. DIAGNOSTIC EVALUATION
• History Collection
• Physical Examination
• Blood Cultures To know the organism
• White blood cell count, ESR
• Echocardiogram - Valve Structure, Regurgitation, Presence of
Vegetation, Ventricular Function

11. MANAGEMENT
• ANTIBIOTICS – Inj.Penicillin , IV , 2-6 WKS or Ampicillin +
Flucloxacillin +Gentamicin
• AMPHOTERICIN-B - Fungal Endocarditis
• Administer PCM 1g tds p.o
• Monitor Temperature
• Psychological Support

12. SURGICAL MANAGEMENT
Valve Replacement

13. NURSING MANAGEMENT
NURSING DIAGNOSIS:
1. Acute pain related to systemic effects of infection.
2. Risk for decreased cardiac output related to disorders of
the heart valves and the endothelium.
3. Altered body temperature related to the infection process.
4. Risk for Ineffective tissue perfusion related to embolization

14. NURSING MANAGEMENT
INTERVENTIONS
• Assess the complaint of chest pain. Pay attention to nonverbal cues of
discomfort.
• Monitor frequency / rhythm, heart sounds.
• Provide a quiet environment and comfort measures, such as: changes
in position, back rub
• Provide diversional activities.

15. NURSING MANAGEMENT
INTERVENTIONS
• Assess for dehydration, diaphoresis, poor skin turgor, dry mucous
membranes.
• Measure the body temperature 4-8 hours.
• Monitor the input and output of fluids every 8 hours.
• Monitor the IV presence of redness and swelling, change places every
24 hours
• Administer antibiotics ,antipyretic

16. NURSING MANAGEMENT
• Assess for signs of embolization, report any signs of
embolization to the doctor immediately.
• Perform a neurological examination
• Instruct the client about the need to continue anticoagulation, if
ordered for further prevent embolic period.
• Encourage active with range of motion exercises as tolerated.
• Administer anticoagulant therapy

17. NURSING MANAGEMENT
• Assess all invasive lines and wounds for Redness,
Swelling
• Assess Heart Sounds /Murmurs
• Psychological Support

19. Congenital Heart Disease- Blood moves at high velocity
across defects such as VSD's, stenotic or leaky valves, and PDA's.
This high velocity flow facilitates the sticking of the blood's
clotting elements to these defects. If bacteria are in the blood
stream, they become enveloped in the clot adhering to the defect
and endocarditis may develop ther