Inflammatory Cardiac Disease (Endocarditis)

Endocarditis

Inflammation of the heart's and its valves' inner lining is known as endocarditis. Bacteria that enter the bloodstream and settle in the heart lining, a heart valve, or a blood artery produce an illness known as infectious endocarditis (IE). Severe valve insufficiency, which can result in congestive heart failure and myocardial abscesses, is one of its intracardiac consequences. It is a dangerous condition that will be fatal if left untreated.

The risk of endocarditis may be increased by bacterial invasion and particular heart conditions. Endocarditis is caused by numerous factors, including:

• Organisms: Beta hemolytic streptococcus, staphylococcus aureus, gonococcus, fungi, and rickettsia are among the bacteria.
• Cardiac pathological condition: Rh-heart disease, congenital heart disease, degenerative heart disease, cardiac surgery
• Invasive procedures: Dental procedure, minor surgery, insertion of indwelling catheter, regional surgery, IV catheter, IV drug users
• Immunosuppression: Cancer, hepatitis, burns

Pathophysiology of Endocarditis

There are numerous ways for microbes to enter the bloodstream.

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Colonization starts on the endothelium.

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The inner lining of the heart is where replication takes place.

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The encroaching microorganism is surrounded by platelets and fibrin, forming a protective covering.

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Expand the diseased plant life

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Scarring, progressive fibrosis, and classification

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Valve loses flexibility, thickens over time, and becomes shorter than usual.

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Keep the closing valve closed.

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Stenosis of the valve

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Difficulty-pump failure

Sign and symptoms

• Tiredness, fever, anorexia, and weight loss
• Chest discomfort, edema, petechiae, murmur, and dyspnea
• Splinter bleeding in the nail beds
• On the pads of the fingers, palms, and toes are Osler's nodes, which are reddish, sensitive lesions.
• Non-tender hemorrhagic lesions called Janeway lesions can appear on the fingers, toes, nose, or ear lobes.
• Embolic problems brought on by plant debris entering the bloodstream
• Proteinuria, hematuria, and arthralgia—an immune reaction
• Splenomegaly
• The fingers are clubbed.

Heart failure, uncontrolled/refractory infection, embolic episodes-CVA, and conduction issues are all side effects of infectious endocarditis.

Diagnosis

• History of invasive operations, various health issues, and congenital and acquired heart disease
• Chest X-ray, echocardiography, and ECG
• Fever, heart murmurs, petechiae, splinter or subungual hemorrhages, Osler's nodes, splenomegaly, etc. are all physical examination findings.
• Blood tests for WBC, ESR, and Hgb,
• Aso término +ve

Medical Management

Eliminating the infectious organism is the major objective of treatment. The management consists of:

• Pharmacological management
  • Antibiotics tailored to a cultured organism's susceptibility to streptomycin, such as penicillin G, gentamycin, and streptomycin
  • Anticoagulant medication
  • Antipyretics
• Surgery to replace the damaged valve, remove lesions (gangrene and emboli), drain an abscess, and other procedures

Nursing Interventions

• Maintain appropriate cardiac output, monitor BP and pulse, observe an elevated JVP, and be aware of heart failure symptoms.
• Listen for heartbeats and crackles in the lung fields (rales)
• Record output and intake
• Rest and exercise should be matched to prevent the production of thrombi.
• Keep your anti-embolism stocking on.
• Administering IV antibiotics as directed
• Maintain a proper body temperature, hydration level, and nutritional state.
• Keep an eye out for indications of emboli:
  • Rebound abdominal tenderness and splenic-sudden abdominal pain extending to the left shoulder
  • Hematuria, pyuria, and groin-radiating renal-flank pain
  • CNS: aphasia, dysphagia, and confusion
  • Cough, dyspnea, and pleuritic chest discomfort in the lungs
  • Check for petechiae on the mucous membrane and conjunctiva.
• Consider blood CS findings
• Check for clubbing of the fingers, Osler's nodes, janeway lesions, and splinter hemorrhage.
• Adhere to the fundamental rules of infection prevention
• Lessen anxiety
• Prepare and set up the discharge
• Give instruction:
  • Educate the patient on the warning signs and symptoms of problems and urge them to contact the doctor if they occur.
  • Educate the patient on the value of maintaining good dental hygiene
  • Avoiding people who have known infections
  • The name, purpose, dosage, frequency, and side effects of antibiotic medication
  • Endocarditis symptoms that reoccur frequently
  • Why prophylactic antibiotics are important before any invasive operations