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    Infective Endocarditis

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    Muzzaffer Hussain
    Infective endocarditis is a microbial infection of the heart valves, lining of the cardiac chambers, or blood vessels. It is commonly caused by bacteria like viridans group streptococci from the mouth or skin bacteria like Staphylococcus aureus. The microbes infect damaged areas of the heart, forming vegetations that can embolize to other organs. Symptoms may include fever, heart murmurs, embolic events, and signs of heart or kidney failure. Diagnosis involves blood cultures, echocardiography to detect vegetations, and lab tests. Treatment consists of intravenous antibiotics and possibly cardiac surgery to repair or replace infected valves. Dental procedures require antibiotic prophylaxis in high-risk patients

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    Infective Endocarditis

    Uploaded by

    Muzzaffer Hussain
    88 views18 pages
    Infective endocarditis is a microbial infection of the heart valves, lining of the cardiac chambers, or blood vessels. It is commonly caused by bacteria like viridans group streptococci from the mouth or skin bacteria like Staphylococcus aureus. The microbes infect damaged areas of the heart, forming vegetations that can embolize to other organs. Symptoms may include fever, heart murmurs, embolic events, and signs of heart or kidney failure. Diagnosis involves blood cultures, echocardiography to detect vegetations, and lab tests. Treatment consists of intravenous antibiotics and possibly cardiac surgery to repair or replace infected valves. Dental procedures require antibiotic prophylaxis in high-risk patients

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    Infective endocarditis is a microbial infection of the heart valves, lining of the cardiac chambers, or blood vessels. It is commonly caused by bacteria like viridans group streptococci from the mouth or skin bacteria like Staphylococcus aureus. The microbes infect damaged areas of the heart, forming vegetations that can embolize to other organs. Symptoms may include fever, heart murmurs, embolic events, and signs of heart or kidney failure. Diagnosis involves blood cultures, echocardiography to detect vegetations, and lab tests. Treatment consists of intravenous antibiotics and possibly cardiac surgery to repair or replace infected valves. Dental procedures require antibiotic prophylaxis in high-risk patients

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    88 views18 pages

    Infective Endocarditis

    Uploaded by

    Muzzaffer Hussain
    Infective endocarditis is a microbial infection of the heart valves, lining of the cardiac chambers, or blood vessels. It is commonly caused by bacteria like viridans group streptococci from the mouth or skin bacteria like Staphylococcus aureus. The microbes infect damaged areas of the heart, forming vegetations that can embolize to other organs. Symptoms may include fever, heart murmurs, embolic events, and signs of heart or kidney failure. Diagnosis involves blood cultures, echocardiography to detect vegetations, and lab tests. Treatment consists of intravenous antibiotics and possibly cardiac surgery to repair or replace infected valves. Dental procedures require antibiotic prophylaxis in high-risk patients

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 18

    INFECTIVE ENDOCARDITIS

    By:Muzzaffer Hussain

    INFECTIVE ENDOCARDITIS

    1. It is a microbial infection Of a heart


    valve(native or Prosthetic),the lining of cardiac chamber or blood vessel,or a congenital anomaly (e.g.septal defect).

    CAUSATIVE ORGANISM
    1.Bacteria. 2.Ricketsia. 3.Fungus. 4.Chlamidia.

    Microbiology
    1. Viridans group of Streptococci (common in
    Upper respiratory Tract &Oral cavity-Displaced during Tooth brushing,Dental Treatment). 2.Enterococcus faecalis- from bowel or urinary tract. 3. Staph aureuscommon cause of Acute Endo Originating from skin inf,abscess,vascular access sites(i.v.lines,central venous line,i.v. drug abusers),Srteptococcus pneumonae. 4.Gram neg BactH influenzae, 5.Brucella,Fungi-candida,Aspergillus,Rickettsia

    Pathophysiology
    Occurs at pre existing Endocardial damage
    .

    Virulent organism(Staph aureus)-Normal


    valve-Acute,Damaged Valves- SABE.

    Particular areas-Endocardial damage by


    high pressure jet-blood(VSD)

    Infection at Endothelial Damage sitesAttracts platelet,firin-blood borne organism Infection established-Vegetations-break away Embolisation-vasculitis,skin lesion,immune complex deposition Infarction of spleen,kidney,glomerulonephritis

    Clinical Features
    Acute-Severe febrile illness,prominent or changing heart murmurs,petechae,Embolic events common,cardiac or renal failure.ECHO-Abscess. SABESuspected when pt known to have CHD,Chronic RHD develop persistent fever,unusual tiredness,night sweats,wt loss,New signs of valve dysfunction or Heart failure. Rarely-Embolic Stroke,Pripheral arterial Embolism,cerebral Emboli`

    Peripheral SignsPurpura & Petechial Haemorrhages in the skin & mucous membrane. Splinter Haemorrhages under finger & toe nails Oslers nodes-painful,tender swelling at finger tips-vasculitis. Digital clubbing-late Spleen-palpable Microscopic haematuria-Glomerulonephritisimmune complex Varying cardiac murmurs

    INVESTIGATIONS 1. Blood Culture- 3 Specimens from different sites prior to AntibioticAerobic & Anaerobic cultures. 2.ECHO cardiographyKey inv to detect vegetations,assess &follow progress of valve damage,detect abscess formation.Failure to detect vegetation does not rule out SABE.

    3.Raised ESR,Normocytic Normochromic Anaemia, Raised TLC,Thrombocytopenia,Plasma CRP-Raised, 4.Urine-Proteinuria,Micro haematuria 5.ECG-Conduction defects(due to abscess formation) 6.Xray ChestCardiomegaly,Cardiac Failure

    Diagnosis of SABE Major Criteria

    1. Positive Blood Culture 2. Endocardial Involvement-Positive ECHO,


    New valvular Regurgitation .

    Minor Criteria
    1.Predisposing Val/cardiac abn 2.Intravenous Drug misuse 3.Pyrexia>38 C 4. Embolic Phenomena 5. Vasculitic phenomena 6.Blood Culture suggestive 7.ECHO-suggestive Definite-2 Major,1 major&3 minor,5 minor Possible1 major&1 minor or 3 minor

    Management
    1. Source of infection Removed-Vascular access
    removed,apical abscess treated. 2. Empirical Antibiotics-St viridans-Benzyl pen1-2M U IV-4 hrly+Genta-80mg IV -12hrly; EnteroAmpi+Genta;StaphPen sen-Benzyl Pen+Genta;Pen ResClox+Genta;Pen&meth ResVancomycin+Genta

    3.Cardiac Surgery-Debridement of infected


    material-with staph & fungal infection &valve replacementAntibiotic before surgery.

    PREVENTION(In Vavular & congenital HD) 1. Maintain Good Oral Hygiene & Dental Health 2. Antibiotic Prophylaxis Against IE A.Dental/UR Procedures Amoxycillin-3g orally under local anaesthetics 1 hour before Allergic to Pen Clindamycin-600mg B.Dental/UR Pro under Amoxycillin-1 g iv at Gen Anaeshesia induction+0.5 g orally 6 hrs later Allergic to Pen Vancomycin-1 g iv inf+ Gentamicin-120mg iv at induction

    Special RiskPatients, Amoxycillin-1 giv+ ie Prosthetic valves,Previous Gentamicin-120mg Endocarditis, iv at induction+ Genitourinary procedures-- Amoxy-0.5g orally 6 hrs later Allergic to Pen Vancomycin1.0g+ 120mg Genta iv at induction

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