Page 79 - Critical Care Notes

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Infections of the Heart
Endocarditis
Endocarditis is the inflammation of the innermost layer of the heart. It can include
the heart valves, chordae tendineae, cardiac septum, or lining of the cham-
bers. It is caused typically by bacterial infections (Streptococcus viridans or
Staphylococcus aureus).
Pathophysiology
Microbe invades the valve leaflets → infection occurs, causing valve leaflets to
be deformed.
Clinical Presentation
Endocarditis manifests as:
■ Low-grade and intermittent fever
■ Chills, night sweats
■ Anorexia, weight loss
■ Myalgia, arthralgia
■ Extreme fatigue and malaise
■ Nausea and vomiting
■ Headache
■ SOB
■ Chest pain
■ Abdominal pain
■ Confusion, delirium
■ Pain in the muscles, joints, and back
■ Influenza-like symptoms
■ Loud regurgitant murmur; pericardial rub, or friction rub
■ Possible embolic stroke with focal neurological deficits
Be suspicious if petechiae appear on the conjunctiva, neck, anterior chest,
abdomen, or oral mucosa. Look for Janeway lesions (nontender macule) on
patient’s palms and soles, Osler’s nodes (tender, erythematous, raised nodules)
on fingers and toe pads, and splinter hemorrhages under fingernails. Roth’s
spots are white spots that can be seen on the retina.
Diagnostic Tests
■ Transthoracic echocardiogram
■ ECG
■ Chest x-ray
■ Abdominal CT or MRI
■ Positive blood cultures
■ Refer to the Duke Criteria for Infective Endocarditis found at: http://www.
medcalc.com/endocarditis.html
CV