Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves. Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or the surfaces of intracardiac devices. Endocarditis is characterized by lesions, known as vegetations, which is a mass of platelets, fibrin, microcolonies of microorganisms, and scant in?ammatory cells.In the subacute form of infective endocarditis, the vegetation may also include a center of granulomatous tissue, which may fibrose or calcify.
Signs and symptoms include fever, chills, sweating, malaise, weakness, anorexia, weight loss, splenomegaly, flu like feeling, cardiac murmur, heart failure, petechia of anterior trunk, Janeway's lesions, etc.The initial symptoms of endocarditis are similar to the flu and include: a high fever (101.4oF), chills, headache, joint and muscle pain. Endocarditis may develop slowly or suddenly depends on the cause of the infection and whether you have any underlying heart problems. Endocarditis signs and symptoms vary, but may include: Fever and chills, A new heart sound made by blood rushing through your heart, Fatigue, Aching joints and muscles, Night sweats, Shortness of breath, Paleness, Persistent cough, Swelling in your feet, legs or abdomen, Unexplained weight loss, Blood in your urine (either visible or found in a doctor's viewing of your urine under a microscope), Tenderness in your spleen is an infection-fighting abdominal organ on your left side, just below your rib cage, Osler's nodes are red and tender spots under the skin of your fingers, Petechiae is a tiny purple or red spots on the skin, whites of your eyes or inside your mouth.
The incidence of IE in other countries is similar to that in the United States. From 1998-2009, the proportion of patients with intracardiac devices increased from 13.3% to 18.9%, while the proportion of cases with a background of HIV infection or HIV drug abuse fell.In the United States, the 2009 incidence of IE was approximately 12.7 cases per 100,000 persons per year.
The major goals of therapy for infective endocarditis (IE) are to eradicate the infectious agent from the thrombus and to address the complications of valvular infection. The latter includes both the intracardiac and extracardiac consequences of IE. Some of the effects of IE require surgical intervention. Emergent care should focus on making the correct diagnosis and stabilizing the patient with acute disease and cardiovascular instability.
General measures include the following:
• Treatment of congestive heart failure
The treatment is of types: Antibiotic therapy, Anticoagulation Therapy, Surgery, Vancomycin may also be used if tests reveal that your infection is caused by bacteria that have developed a resistance to penicillin and gentamicin, such as the meticillin-resistant staphylococcus aureus (MRSA) strain of bacteria. In the setting of acute IE, institute antibiotic therapy as soon as possible to minimize valvular damage. Three to 5 sets of blood cultures are obtained within 60-90 minutes, followed by the infusion of the appropriate antibiotic regimen. The initial antibiotic choice is empiric in nature, determined by clinical history and physical examination findings.