3. Valve - Endocarditis.docx - CHAPTER 37 Inflammatory and...

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CHAPTER 37: Inflammatory and Structural Heart Disorders CHAPTER 37: Inflammatory and Structural Heart Disorders Infective Endocarditis : : p. 841 p. 841 Infection of the inner layer of the heart that usually affects the cardiac valves Almost always a fatal condition until development of penicillin 15,000 new cases diagnosed in the United States each year Classified as either acute or subacute; Can also be classified by cause Subacute form Subacute form Preexisting valve disease Insidious onset; Longer clinical course Caused by enterococci Acute form Acute form Healthy valves Rapid onset; Shorter clinical course Causes… Causes… Intravenous drug abuse Fungal endocarditis Site of involvement: Prosthetic valve endocarditis Causative Organisms Causative Organisms Strep tococcus viridians; Staph ylococcus aureus Viruses; Fungi Pathophysiology: Pathophysiology: Occurs when blood turbulence within heart allows causative agent to infect previously damaged valves or other endothelial surfaces Vegetations * Primary lesions of IE * Made up of fibrin, leukocytes, platelets, and microbes that stick to valve surface * Lesions can embolize to many sites * Cause limb infarctions, strokes, organ damage * Left: Kidney? Arm? Brain? * Right: Where would emboli travel to? Lungs Pathogenesis of IE Pathogenesis of IE Risk Factors: Age; Intravenous drug abuse (IVDA); Prosthetic valves; Use of intravascular devices ( PIC/Central line ); Renal dialysis Etiology and Pathophysiology Vegetation Fibrin, leukocytes, platelets, and microbes Adhere to the valve or endocardium Embolization of portions of vegetation into circulation Bacterial Endocarditis of the Mitral Valve ( SBE ) Subacute Subacute Clinical Manifestations Clinical Manifestations Arthralgia; Myalgia Back pain Abdominal discomfort Weight loss Headache Clubbing of fingers Clinical Manifestations Nonspecific… Low grade Fever (90% of patients) Chills Weakness Malaise Fatigue Anorexia Splinter hemorrhages : black longitudinal streaks in nail beds (vascular) Petechia … (Conjunctivae, lips, bucchal, palate, ankles) due to microembolism of vegetative lesions Janeway’s lesions… (small, flat lesions on palms, soles) Roth’s spots… (retina) New murmur or change in murmur
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HF… (80% aortic stenosis, 50% mitral) Clinical Manifestations cont… Clinical Manifestations cont… Murmur in most patients: Aortic and mitral valves most commonly affected Heart failure in up to 80% with aortic valve endocarditis and 50% of mitral valve * Why? Fibrin on aortic valve causes decreased CO and backs up blood into pulmonary system * What assessment findings would you expect to see? * Aortic thrombosis (6P’s- pain, paresthesias, pulseless, pallor, …?) Signs and symptoms of embolism * What would we expect to see??
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