GROUP 5
INFECTIVE ENDOCARDITIS AND RHEUMATIC
ENDOCARDITIS
MATRIC NUMBERS
BMS/21/22/0439 Olusanya Deborah
BMS/21/22/0409 Okubajo Titilope Abigael
BMS/21/22/0447 Oluwatamilore Divine Chika
BMS/21/22/0395 Ogunteluwo tolulope adyemi
BMS/21/22/0460 Onasanya Mojisola Oluwaseyi
BMS/21/22/0477 Oso Boluwatife
BMS/21/22/0457 Onadipe Damola solafunmi
BMS/21/22/0466 Oresanya Oluwapelumi Susan
Infective Endocarditis: Definition
Infective endocarditis (IE) is a serious infection of the
endocardium, the inner lining of the heart chambers and
valves. This infection is caused by microorganisms, primarily
bacteria, fungi, or, rarely, viruses. It commonly affects the heart
valves and can lead to severe complications such as valve
destruction, heart failure, and systemic embolization.
: Predisposing Factors
1. Intravenous drug use: This introduces microorganisms
directly into the bloodstream.
2. Prosthetic heart valves: Artificial valves are more prone to
infection.
3. Congenital heart defects: Structural abnormalities increase
the risk of bacterial attachment.
4. Rheumatic heart disease: Damaged valves from previous
inflammation are vulnerable.
5. Previous episodes of endocarditis: A history of IE increases
susceptibility.
6. Immunosuppression or malignancy: Weakened immune
systems facilitate infections.
: Types & Causes
Types:
1. Acute Infective Endocarditis: A rapidly progressing
condition caused by virulent organisms such as
*Staphylococcus aureus*. It often affects previously healthy
valves.
2. Subacute Infective Endocarditis: Slower in onset and
progression, caused by less virulent organisms like
*Streptococcus viridans*. It usually occurs in damaged or
abnormal valves.
Causes:
• Bacteria: *Staphylococcus aureus*, *Streptococcus viridans*
• Fungi: *Candida* species
• Viruses: Rarely implicated in IE
Pathophysiology
1. Endocardial injury occurs due to factors like turbulence from
valvular abnormalities or invasive procedures.
2. Platelet and fibrin deposition on the injured site forms a
nidus for infection.
3. Microbial adherence and colonization occur, facilitated by
bloodstream microorganisms.
4. Vegetations form, consisting of microorganisms, fibrin, and
platelets.
5. Vegetations can embolize, leading to systemic infection and
organ damage.
Signs and Symptoms
1. Fever, chills, and night sweats: These systemic signs reflect
the body’s inflammatory response to infection.
2. Fatigue and malaise: Chronic inflammation and reduced
cardiac efficiency contribute to these symptoms.
3. New or changing heart murmur: Damaged valves
produce abnormal heart sounds due to turbulent blood
flow.
4. Petechiae and splinter hemorrhages: Small capillary
hemorrhages appear as tiny spots on the skin, mucosa,
or under nails.
5. Osler nodes, Janeway lesions, and Roth spots: Specific
skin and eye findings caused by immune complexes or
embolization.
Diagnostics
1. Blood cultures: Repeated blood samples are cultured
to isolate causative organisms. Positive cultures confirm
the diagnosis.
2. Echocardiography: Non-invasive transthoracic or
transesophageal echocardiography detects vegetations
and assesses valve damage.
3. Complete blood count (CBC): Elevated white blood
cells indicate infection; anemia may result from chronic
disease.
Management
MEDICAL MANAGEMENT:
• Prolonged intravenous antibiotics for 4-6 weeks to
eradicate the causative organism.
• Antifungal therapy for fungal infections.
• Surgical intervention to repair or replace damaged
valves in severe cases.
NURSING MANAGEMENT: • Monitor vital signs, heart
sounds, and signs of embolism.
• Administer prescribed medications and monitor therapeutic
response.
• Educate patients on maintaining good oral hygiene and
prophylactic antibiotic use.
NURSING DIAGNOSES
1. Fatigue related to systemic infection and decreased cardiac
output evidenced by patient reports of exhaustion, inability to
perform daily activities, and increased need for rest.
2. Ineffective Tissue Perfusion related to embolization of
vegetative lesions evidenced by cold extremities, cyanosis, and
delayed capillary refill.
3. Decreased Cardiac Output related to valvular damage from
infection evidenced by tachycardia, hypotension, and dyspnea
on exertion.
Infective Endocarditis: Complications
1. Heart failure: Valvular damage leads to impaired cardiac
function.
2. Systemic embolism: Vegetation fragments can travel to the
brain, lungs, or other organs.
3. Abscess formation: Localized infection may form within the
heart or adjacent tissues.
RHEUMATIC ENDOCARDITIS: DEFINITION
Rheumatic endocarditis is an inflammatory condition affecting
the heart valves and endocardium. It results from acute
rheumatic fever, a delayed autoimmune response to group A
beta-hemolytic *Streptococcus* infection, typically of the
throat. Repeated episodes can lead to chronic valvular damage.
Predisposing Factors
1. Untreated or recurrent streptococcal infections: This
increases the risk of acute rheumatic fever.
2. Poor socioeconomic status: Limited access to healthcare
delays treatment of streptococcal infections.
3. Crowded living conditions: Increase exposure to group A
*Streptococcus*.
Signs and Symptoms
1. Fever and joint pain (migratory polyarthritis): Systemic
inflammation affects multiple joints, causing pain and swelling.
2. Heart murmur: Valvular inflammation and damage lead to
turbulent blood flow and abnormal heart sounds.
3. Subcutaneous nodules and erythema marginatum: Non-
painful nodules over bony prominences and a characteristic
skin rash.
4. Chorea (involuntary movements): Autoimmune damage to
the basal ganglia causes rapid, jerky movements.
Diagnostics
1. Positive throat culture for *Streptococcus*: Confirms a
recent streptococcal infection.
2. Elevated antistreptolysin O (ASO) titer: Indicates a recent or
past streptococcal infection.
3. Echocardiography: Detects structural or functional changes
in heart valves due to inflammation.
Management
MEDICAL MANAGEMENT:
• Antibiotics to eliminate *Streptococcus* infection.
• Anti-inflammatory therapy (aspirin or corticosteroids) to
control inflammation.
• Long-term antibiotic prophylaxis to prevent recurrent
infections.
NURSING MANAGEMENT:
• Administer medications as prescribed.
• Monitor for signs of cardiac complications and educate
patients on early treatment of sore throats.
NURSING DIAGNOSIS
1. Decreased Cardiac Output related to valvular damage secondary to
inflammation evidenced by dyspnea, tachycardia, and reduced ejection
fraction on echocardiogram.
2. Acute Pain related to inflammatory processes in heart tissues
evidenced by.patient complaints of chest discomfort and grimacing
during movement.
3. Activity Intolerance related to impaired cardiac function evidenced by
excessive fatigue and shortness of breath on exertion.
: Complications
1. Chronic valvular disease: Long-term damage to heart
valves can lead to regurgitation or stenosis.
2. Heart failure: Impaired valve function results in
decreased cardiac output.
3. Arrhythmias: Structural changes in the heart may
disrupt normal electrical conduction.
Differences and Similarities
Differences:
• Infective Endocarditis: Caused by microorganisms,
such as bacteria or fungi, and has an acute or subacute
onset.
• Rheumatic Endocarditis: Autoimmune-mediated
inflammation triggered by group A *Streptococcus*
infection.
Similarities:
• Both affect the heart valves and endocardium.
• Both can lead to heart murmurs and complications
like heart failure.
