{"id":5634,"date":"2025-12-13T16:25:22","date_gmt":"2025-12-13T21:25:22","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/?post_type=chapter&#038;p=5634"},"modified":"2025-12-13T17:53:48","modified_gmt":"2025-12-13T22:53:48","slug":"infective-endocarditis","status":"web-only","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/chapter\/infective-endocarditis\/","title":{"raw":"7p24  Infective Endocarditis","rendered":"7p24  Infective Endocarditis"},"content":{"raw":"<strong>Infective Endocarditis \u2013 Diagnostic Tools, Signs, Symptoms, and Complications<\/strong>\r\n<h1><strong>Overview:<\/strong><\/h1>\r\n<ul>\r\n \t<li>An infection of the inner lining of the heart, primarily affecting the\u00a0<strong>heart valves<\/strong>.<\/li>\r\n \t<li>Most common bacterial causes:\r\n<ul>\r\n \t<li><strong>Streptococcus viridans:<\/strong>\u00a0Usually causes less severe symptoms.<\/li>\r\n \t<li><strong>Staphylococcus aureus:<\/strong>\u00a0Typically results in more aggressive infections.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<h1>Risk Factors:<\/h1>\r\n<ul>\r\n \t<li>Most individuals are\u00a0<em>not<\/em>\u00a0susceptible to bacteria entering the bloodstream and causing valve infections.<\/li>\r\n \t<li>Risk increases in the presence of\u00a0<strong>valvular abnormalities<\/strong>\u00a0or\u00a0<strong>compromised immunity<\/strong>.<\/li>\r\n<\/ul>\r\n<strong>Major Risk Factors:<\/strong>\r\n<ol>\r\n \t<li><strong>Valve abnormalities:<\/strong>\r\n<ul>\r\n \t<li><strong>Congenital valve defects:<\/strong>\u00a0Structural issues present from birth.<\/li>\r\n \t<li><strong>History of rheumatic fever:<\/strong>\u00a0Damage from\u00a0<strong>group A beta-hemolytic Streptococcus<\/strong>\u00a0in childhood causes valve scarring, making valves vulnerable.<\/li>\r\n \t<li><strong>Prolapse or damage:<\/strong>\u00a0Valves that have\u00a0<strong>prolapsed<\/strong>\u00a0or been\u00a0<strong>replaced<\/strong>\u00a0(mechanical or biological valves\/pigs) are less effective at defending against bacteria.<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><strong>Procedural Sources:<\/strong>\r\n<ul>\r\n \t<li><strong>Dental procedures:<\/strong>\r\n<ul>\r\n \t<li>Scaling or cavity cleaning can cause\u00a0<strong>microbleeding<\/strong>\u00a0and provide portals for bacteria.<\/li>\r\n \t<li>Common bacteria:\u00a0<em>Streptococcus viridans<\/em>, often present in the mouth.<\/li>\r\n \t<li>Prophylactic\u00a0<strong>antibiotics<\/strong>\u00a0are given beforehand to prevent bacteria from settling on vulnerable valves.<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><strong>Piercings and tattoos:<\/strong>\r\n<ul>\r\n \t<li>Risk of bacteria entering through skin breaches.<\/li>\r\n \t<li>Patients with valve abnormalities are advised to take precautions.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><strong>Immunosuppression:<\/strong>\r\n<ul>\r\n \t<li>Reduced immune function increases susceptibility.<\/li>\r\n \t<li>Common in\u00a0<strong>elderly<\/strong>,\u00a0<strong>cancer patients<\/strong>, those on\u00a0<strong>immunosuppressive medications<\/strong>.<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><strong>IV Drug Use:<\/strong>\r\n<ul>\r\n \t<li>Use of\u00a0<strong>dirty needles<\/strong>\u00a0introduces bacteria directly into the bloodstream.<\/li>\r\n \t<li>High risk of infecting heart valves or other sites.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ol>\r\n<strong>Additional Risk Considerations:<\/strong>\r\n<ul>\r\n \t<li><strong>Surgical history or prosthetic valves:<\/strong>\r\n<ul>\r\n \t<li>Artificial or prosthetic valves have less defense, increasing risk.<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><strong>History of recent surgery:<\/strong>\r\n<ul>\r\n \t<li>Provides an entry point for bacteria.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<h1><strong>Pathogenesis:<\/strong><\/h1>\r\n<ul>\r\n \t<li>Infection begins\u00a0<strong>in the bloodstream<\/strong>\u00a0after a\u00a0<strong>portal of entry<\/strong>\u00a0such as a wound or other source (perhaps abrasion during dental cleaning).<\/li>\r\n \t<li>Bacteria\u00a0<strong>travel via blood<\/strong>\u00a0to reach vulnerable sites\u2014mainly\u00a0<strong>heart valves<\/strong>, which are poorly vascularized.<\/li>\r\n \t<li><strong>Valve damage:<\/strong>\r\n<ul>\r\n \t<li>Bacteria\u00a0<strong>adhering<\/strong>\u00a0to the valves cause\u00a0<strong>deterioration<\/strong>\u00a0and\u00a0<strong>growths<\/strong>.<\/li>\r\n \t<li>The immune response involves\u00a0<strong>white blood cell infiltration<\/strong>\u00a0but often leads to tissue damage.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<strong>Formation of Vegetations:<\/strong>\r\n<ul>\r\n \t<li>Vegetations are\u00a0<strong>large, fragile masses<\/strong>\u00a0made of:\r\n<ul>\r\n \t<li><strong>Fibrin<\/strong><\/li>\r\n \t<li><strong>Platelets<\/strong><\/li>\r\n \t<li><strong>Blood cells<\/strong><\/li>\r\n \t<li><strong>Bacteria<\/strong><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li>These\u00a0<strong>growths<\/strong>\u00a0are seen on the\u00a0<strong>cusps of heart valves<\/strong>\u00a0and can embolize, causing further complications.<\/li>\r\n<\/ul>\r\n<h1><strong>Diagnostic Imaging:<\/strong><\/h1>\r\n<ol>\r\n \t<li><strong>Transesophageal echocardiogram (TEE):<\/strong>\r\n<ul>\r\n \t<li>Provides\u00a0<strong>high-resolution images<\/strong>\u00a0of the valves by inserting a probe into the esophagus.<\/li>\r\n \t<li>Superior to transthoracic echocardiography (TTE) because of proximity to the heart and less interference from ribs.<\/li>\r\n \t<li>Helps detect\u00a0<strong>vegetations<\/strong>\u00a0and\u00a0<strong>valve damage<\/strong>\u00a0effectively.\r\n<ul>\r\n \t<li style=\"list-style-type: none\">\r\n<ul>\r\n \t<li>Visualizes vegetations (infected growths) on heart valves.<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li>Example: Large vegetation on the\u00a0<strong>aortic valve<\/strong>\u00a0can impair blood flow, reducing\u00a0<strong>stroke volume<\/strong>\u00a0and\u00a0<strong>cardiac output<\/strong>.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><strong>2D echocardiograms<\/strong>\u00a0can show\u00a0<strong>messy, irregular growths<\/strong>\u00a0on valves such as the mitral valve.\r\n<ul>\r\n \t<li><strong>Color Doppler echocardiography<\/strong>\u00a0helps detect\u00a0<strong>regurgitation<\/strong>\u00a0(backflow of blood) through diseased valves.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ol>\r\n<h1><strong>Signs and Symptoms:<\/strong><\/h1>\r\n<ul>\r\n \t<li><strong>Fever<\/strong>: Common due to bacterial infection.<\/li>\r\n \t<li><strong>Fatigue &amp; Anorexia:<\/strong>\u00a0Body uses resources for fighting infection, resulting in loss of appetite.<\/li>\r\n \t<li><strong>Murmurs:<\/strong>\u00a0As valves become leaky or stenotic, abnormal sounds (regurgitation or narrowing) are heard via stethoscope.<\/li>\r\n \t<li><strong>Splenomegaly:<\/strong>\u00a0Enlargement of the spleen due to immune activity.<\/li>\r\n \t<li><strong>Petechiae and Osler Nodes:<\/strong>\r\n<ul>\r\n \t<li><strong>Osler Nodes:<\/strong>\u00a0Tender, painful nodules typically on fingers or toes, caused by\u00a0<strong>septic emboli<\/strong>\u00a0lodging in dermal capillaries.<\/li>\r\n \t<li><strong>Petechiae:<\/strong>\u00a0Small bleeding spots on skin from capillary damage.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<h1><strong>Complications:<\/strong><\/h1>\r\n<ul>\r\n \t<li><strong>Septic Emboli:<\/strong>\r\n<ul>\r\n \t<li>Clusters of bacteria, white blood cells, fibrin, and blood cells break off vegetations.<\/li>\r\n \t<li>Emboli can lodge in distant capillaries, causing\u00a0<strong>vascular occlusion<\/strong>\u00a0or\u00a0<strong>infection<\/strong>.<\/li>\r\n \t<li>Emboli traveling systemically (from\u00a0<strong>left-sided<\/strong>\u00a0vegetations) can cause\u00a0<strong>stroke<\/strong>\u00a0or\u00a0<strong>organ infarctions<\/strong>.<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><strong>Vascular occlusion:<\/strong>\u00a0Can lead to\u00a0<strong>tissue necrosis<\/strong>.<\/li>\r\n \t<li><strong>DIC (Disseminated Intravascular Coagulation):<\/strong>\u00a0Widespread clotting in the bloodstream, increasing risk of bleeding elsewhere.<\/li>\r\n<\/ul>\r\n<h1><strong>Biopsy &amp; Laboratory Tests:<\/strong><\/h1>\r\n<ul>\r\n \t<li><strong>Biopsy of Osler nodes<\/strong>\u00a0or other lesions can identify bacteria responsible.<\/li>\r\n \t<li><strong>Blood cultures:<\/strong>\u00a0Essential for confirming the\u00a0<strong>causative organism<\/strong>\u00a0(e.g.,\u00a0<em>Streptococcus viridans<\/em>,\u00a0<em>Staphylococcus aureus<\/em>).<\/li>\r\n \t<li><strong>Other causes of similar skin lesions<\/strong>\u00a0include insect bites; biopsy helps differentiate.<\/li>\r\n<\/ul>\r\n<h1><strong>Treatment &amp; Management:<\/strong><\/h1>\r\n<ul>\r\n \t<li><strong>Antibiotics<\/strong>\u00a0targeted to the identified bacteria.<\/li>\r\n \t<li><strong>Valve replacement:<\/strong>\u00a0Often needed if valves are severely damaged or cannot heal.\r\n<ul>\r\n \t<li>Diseased valves with vegetations or regurgitation are often replaced with\u00a0<strong>mechanical valves<\/strong>\u00a0or\u00a0<strong>biological (pig)<\/strong>\u00a0valves.\r\n<ul>\r\n \t<li><strong>Valve durability:<\/strong>\r\n<ul>\r\n \t<li>Both last approximately\u00a0<strong>10-20 years<\/strong>.<\/li>\r\n \t<li>Mechanical valves are durable but require lifelong anticoagulation.<\/li>\r\n \t<li>Biological valves last around the same time but usually do not necessitate anticoagulation.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<ul>\r\n \t<li><strong>Managing Heart Failure:<\/strong>\r\n<ul>\r\n \t<li>If signs of\u00a0<strong>congestive heart failure<\/strong>\u00a0are present, initiate heart failure medications (e.g., diuretics, ACE inhibitors).<\/li>\r\n \t<li>Additional interventions like\u00a0<strong>imaging<\/strong> to evaluate valve damage.<\/li>\r\n \t<li>Possible\u00a0<strong style=\"text-align: initial;font-size: 1em\">valve replacement<\/strong><span style=\"text-align: initial;font-size: 1em\">\u00a0if valves are severely damaged or dysfunctional.<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<h1><strong>Prevention:<\/strong><\/h1>\r\n<ul>\r\n \t<li><strong>Dental hygiene:<\/strong>\r\n<ul>\r\n \t<li>Maintaining good dental health reduces\u00a0<strong>gingivitis<\/strong>\u00a0and\u00a0<strong>oral infections<\/strong>.<\/li>\r\n \t<li>Prevention of bacteria from entering the bloodstream during routines like tooth brushing, dental cleaning, or procedures that cause bleeding.<\/li>\r\n \t<li>Good oral hygiene correlates with overall better health status.<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><strong>Other preventive measures:<\/strong>\r\n<ul>\r\n \t<li>High-risk individuals (e.g., with prosthetic valves) may receive\u00a0<strong>prophylactic antibiotics<\/strong>\u00a0before dental work.<\/li>\r\n \t<li>Maintaining overall\u00a0<strong>healthy lifestyle<\/strong>\u2014balanced diet, regular exercise, avoiding smoking.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<h1><strong>Summary:<\/strong><\/h1>\r\nInfective endocarditis results from bacteria traveling through the bloodstream and infecting heart valves. The severity depends on the pathogen, with <em>Staphylococcus aureus<\/em> typically causing more severe disease. Diagnosis is aided by imaging techniques like transesophageal echocardiography which can reveal vegetations on valves, the hallmark of infection. Prompt treatment is essential to prevent embolic events and valve destruction.\r\n\r\nPeople with pre-existing valvular damage, prosthetic valves, or compromised immune systems are at higher risk for infective endocarditis, especially after procedures like dental work or with intravenous drug use. Prophylactic antibiotics and good hygiene practices are critical for prevention in high-risk individuals.\r\n\r\n&nbsp;\r\n\r\nInfective endocarditis presents with fever, murmurs, and embolic phenomena such as Osler nodes. Diagnosis involves echocardiography, blood cultures, and biopsy. Prompt antibiotic therapy and possible surgical intervention are crucial, especially when vegetations cause significant valvular damage or embolic risks.\r\n\r\nEffective treatment of infective endocarditis involves antibiotics tailored to the causative bacteria, addressing heart failure symptoms, and, if necessary, valve repair or replacement. Prevention hinges on good oral hygiene and overall healthy lifestyle choices, including exercise. Advances in prosthetic valves improve outcomes and longevity of valve replacement procedures.\r\n\r\n&nbsp;","rendered":"<p><strong>Infective Endocarditis \u2013 Diagnostic Tools, Signs, Symptoms, and Complications<\/strong><\/p>\n<h1><strong>Overview:<\/strong><\/h1>\n<ul>\n<li>An infection of the inner lining of the heart, primarily affecting the\u00a0<strong>heart valves<\/strong>.<\/li>\n<li>Most common bacterial causes:\n<ul>\n<li><strong>Streptococcus viridans:<\/strong>\u00a0Usually causes less severe symptoms.<\/li>\n<li><strong>Staphylococcus aureus:<\/strong>\u00a0Typically results in more aggressive infections.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h1>Risk Factors:<\/h1>\n<ul>\n<li>Most individuals are\u00a0<em>not<\/em>\u00a0susceptible to bacteria entering the bloodstream and causing valve infections.<\/li>\n<li>Risk increases in the presence of\u00a0<strong>valvular abnormalities<\/strong>\u00a0or\u00a0<strong>compromised immunity<\/strong>.<\/li>\n<\/ul>\n<p><strong>Major Risk Factors:<\/strong><\/p>\n<ol>\n<li><strong>Valve abnormalities:<\/strong>\n<ul>\n<li><strong>Congenital valve defects:<\/strong>\u00a0Structural issues present from birth.<\/li>\n<li><strong>History of rheumatic fever:<\/strong>\u00a0Damage from\u00a0<strong>group A beta-hemolytic Streptococcus<\/strong>\u00a0in childhood causes valve scarring, making valves vulnerable.<\/li>\n<li><strong>Prolapse or damage:<\/strong>\u00a0Valves that have\u00a0<strong>prolapsed<\/strong>\u00a0or been\u00a0<strong>replaced<\/strong>\u00a0(mechanical or biological valves\/pigs) are less effective at defending against bacteria.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Procedural Sources:<\/strong>\n<ul>\n<li><strong>Dental procedures:<\/strong>\n<ul>\n<li>Scaling or cavity cleaning can cause\u00a0<strong>microbleeding<\/strong>\u00a0and provide portals for bacteria.<\/li>\n<li>Common bacteria:\u00a0<em>Streptococcus viridans<\/em>, often present in the mouth.<\/li>\n<li>Prophylactic\u00a0<strong>antibiotics<\/strong>\u00a0are given beforehand to prevent bacteria from settling on vulnerable valves.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Piercings and tattoos:<\/strong>\n<ul>\n<li>Risk of bacteria entering through skin breaches.<\/li>\n<li>Patients with valve abnormalities are advised to take precautions.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li><strong>Immunosuppression:<\/strong>\n<ul>\n<li>Reduced immune function increases susceptibility.<\/li>\n<li>Common in\u00a0<strong>elderly<\/strong>,\u00a0<strong>cancer patients<\/strong>, those on\u00a0<strong>immunosuppressive medications<\/strong>.<\/li>\n<\/ul>\n<\/li>\n<li><strong>IV Drug Use:<\/strong>\n<ul>\n<li>Use of\u00a0<strong>dirty needles<\/strong>\u00a0introduces bacteria directly into the bloodstream.<\/li>\n<li>High risk of infecting heart valves or other sites.<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<p><strong>Additional Risk Considerations:<\/strong><\/p>\n<ul>\n<li><strong>Surgical history or prosthetic valves:<\/strong>\n<ul>\n<li>Artificial or prosthetic valves have less defense, increasing risk.<\/li>\n<\/ul>\n<\/li>\n<li><strong>History of recent surgery:<\/strong>\n<ul>\n<li>Provides an entry point for bacteria.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h1><strong>Pathogenesis:<\/strong><\/h1>\n<ul>\n<li>Infection begins\u00a0<strong>in the bloodstream<\/strong>\u00a0after a\u00a0<strong>portal of entry<\/strong>\u00a0such as a wound or other source (perhaps abrasion during dental cleaning).<\/li>\n<li>Bacteria\u00a0<strong>travel via blood<\/strong>\u00a0to reach vulnerable sites\u2014mainly\u00a0<strong>heart valves<\/strong>, which are poorly vascularized.<\/li>\n<li><strong>Valve damage:<\/strong>\n<ul>\n<li>Bacteria\u00a0<strong>adhering<\/strong>\u00a0to the valves cause\u00a0<strong>deterioration<\/strong>\u00a0and\u00a0<strong>growths<\/strong>.<\/li>\n<li>The immune response involves\u00a0<strong>white blood cell infiltration<\/strong>\u00a0but often leads to tissue damage.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>Formation of Vegetations:<\/strong><\/p>\n<ul>\n<li>Vegetations are\u00a0<strong>large, fragile masses<\/strong>\u00a0made of:\n<ul>\n<li><strong>Fibrin<\/strong><\/li>\n<li><strong>Platelets<\/strong><\/li>\n<li><strong>Blood cells<\/strong><\/li>\n<li><strong>Bacteria<\/strong><\/li>\n<\/ul>\n<\/li>\n<li>These\u00a0<strong>growths<\/strong>\u00a0are seen on the\u00a0<strong>cusps of heart valves<\/strong>\u00a0and can embolize, causing further complications.<\/li>\n<\/ul>\n<h1><strong>Diagnostic Imaging:<\/strong><\/h1>\n<ol>\n<li><strong>Transesophageal echocardiogram (TEE):<\/strong>\n<ul>\n<li>Provides\u00a0<strong>high-resolution images<\/strong>\u00a0of the valves by inserting a probe into the esophagus.<\/li>\n<li>Superior to transthoracic echocardiography (TTE) because of proximity to the heart and less interference from ribs.<\/li>\n<li>Helps detect\u00a0<strong>vegetations<\/strong>\u00a0and\u00a0<strong>valve damage<\/strong>\u00a0effectively.\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li>Visualizes vegetations (infected growths) on heart valves.<\/li>\n<\/ul>\n<\/li>\n<li>Example: Large vegetation on the\u00a0<strong>aortic valve<\/strong>\u00a0can impair blood flow, reducing\u00a0<strong>stroke volume<\/strong>\u00a0and\u00a0<strong>cardiac output<\/strong>.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li><strong>2D echocardiograms<\/strong>\u00a0can show\u00a0<strong>messy, irregular growths<\/strong>\u00a0on valves such as the mitral valve.\n<ul>\n<li><strong>Color Doppler echocardiography<\/strong>\u00a0helps detect\u00a0<strong>regurgitation<\/strong>\u00a0(backflow of blood) through diseased valves.<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<h1><strong>Signs and Symptoms:<\/strong><\/h1>\n<ul>\n<li><strong>Fever<\/strong>: Common due to bacterial infection.<\/li>\n<li><strong>Fatigue &amp; Anorexia:<\/strong>\u00a0Body uses resources for fighting infection, resulting in loss of appetite.<\/li>\n<li><strong>Murmurs:<\/strong>\u00a0As valves become leaky or stenotic, abnormal sounds (regurgitation or narrowing) are heard via stethoscope.<\/li>\n<li><strong>Splenomegaly:<\/strong>\u00a0Enlargement of the spleen due to immune activity.<\/li>\n<li><strong>Petechiae and Osler Nodes:<\/strong>\n<ul>\n<li><strong>Osler Nodes:<\/strong>\u00a0Tender, painful nodules typically on fingers or toes, caused by\u00a0<strong>septic emboli<\/strong>\u00a0lodging in dermal capillaries.<\/li>\n<li><strong>Petechiae:<\/strong>\u00a0Small bleeding spots on skin from capillary damage.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h1><strong>Complications:<\/strong><\/h1>\n<ul>\n<li><strong>Septic Emboli:<\/strong>\n<ul>\n<li>Clusters of bacteria, white blood cells, fibrin, and blood cells break off vegetations.<\/li>\n<li>Emboli can lodge in distant capillaries, causing\u00a0<strong>vascular occlusion<\/strong>\u00a0or\u00a0<strong>infection<\/strong>.<\/li>\n<li>Emboli traveling systemically (from\u00a0<strong>left-sided<\/strong>\u00a0vegetations) can cause\u00a0<strong>stroke<\/strong>\u00a0or\u00a0<strong>organ infarctions<\/strong>.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Vascular occlusion:<\/strong>\u00a0Can lead to\u00a0<strong>tissue necrosis<\/strong>.<\/li>\n<li><strong>DIC (Disseminated Intravascular Coagulation):<\/strong>\u00a0Widespread clotting in the bloodstream, increasing risk of bleeding elsewhere.<\/li>\n<\/ul>\n<h1><strong>Biopsy &amp; Laboratory Tests:<\/strong><\/h1>\n<ul>\n<li><strong>Biopsy of Osler nodes<\/strong>\u00a0or other lesions can identify bacteria responsible.<\/li>\n<li><strong>Blood cultures:<\/strong>\u00a0Essential for confirming the\u00a0<strong>causative organism<\/strong>\u00a0(e.g.,\u00a0<em>Streptococcus viridans<\/em>,\u00a0<em>Staphylococcus aureus<\/em>).<\/li>\n<li><strong>Other causes of similar skin lesions<\/strong>\u00a0include insect bites; biopsy helps differentiate.<\/li>\n<\/ul>\n<h1><strong>Treatment &amp; Management:<\/strong><\/h1>\n<ul>\n<li><strong>Antibiotics<\/strong>\u00a0targeted to the identified bacteria.<\/li>\n<li><strong>Valve replacement:<\/strong>\u00a0Often needed if valves are severely damaged or cannot heal.\n<ul>\n<li>Diseased valves with vegetations or regurgitation are often replaced with\u00a0<strong>mechanical valves<\/strong>\u00a0or\u00a0<strong>biological (pig)<\/strong>\u00a0valves.\n<ul>\n<li><strong>Valve durability:<\/strong>\n<ul>\n<li>Both last approximately\u00a0<strong>10-20 years<\/strong>.<\/li>\n<li>Mechanical valves are durable but require lifelong anticoagulation.<\/li>\n<li>Biological valves last around the same time but usually do not necessitate anticoagulation.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li><strong>Managing Heart Failure:<\/strong>\n<ul>\n<li>If signs of\u00a0<strong>congestive heart failure<\/strong>\u00a0are present, initiate heart failure medications (e.g., diuretics, ACE inhibitors).<\/li>\n<li>Additional interventions like\u00a0<strong>imaging<\/strong> to evaluate valve damage.<\/li>\n<li>Possible\u00a0<strong style=\"text-align: initial;font-size: 1em\">valve replacement<\/strong><span style=\"text-align: initial;font-size: 1em\">\u00a0if valves are severely damaged or dysfunctional.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h1><strong>Prevention:<\/strong><\/h1>\n<ul>\n<li><strong>Dental hygiene:<\/strong>\n<ul>\n<li>Maintaining good dental health reduces\u00a0<strong>gingivitis<\/strong>\u00a0and\u00a0<strong>oral infections<\/strong>.<\/li>\n<li>Prevention of bacteria from entering the bloodstream during routines like tooth brushing, dental cleaning, or procedures that cause bleeding.<\/li>\n<li>Good oral hygiene correlates with overall better health status.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Other preventive measures:<\/strong>\n<ul>\n<li>High-risk individuals (e.g., with prosthetic valves) may receive\u00a0<strong>prophylactic antibiotics<\/strong>\u00a0before dental work.<\/li>\n<li>Maintaining overall\u00a0<strong>healthy lifestyle<\/strong>\u2014balanced diet, regular exercise, avoiding smoking.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h1><strong>Summary:<\/strong><\/h1>\n<p>Infective endocarditis results from bacteria traveling through the bloodstream and infecting heart valves. The severity depends on the pathogen, with <em>Staphylococcus aureus<\/em> typically causing more severe disease. Diagnosis is aided by imaging techniques like transesophageal echocardiography which can reveal vegetations on valves, the hallmark of infection. Prompt treatment is essential to prevent embolic events and valve destruction.<\/p>\n<p>People with pre-existing valvular damage, prosthetic valves, or compromised immune systems are at higher risk for infective endocarditis, especially after procedures like dental work or with intravenous drug use. Prophylactic antibiotics and good hygiene practices are critical for prevention in high-risk individuals.<\/p>\n<p>&nbsp;<\/p>\n<p>Infective endocarditis presents with fever, murmurs, and embolic phenomena such as Osler nodes. Diagnosis involves echocardiography, blood cultures, and biopsy. Prompt antibiotic therapy and possible surgical intervention are crucial, especially when vegetations cause significant valvular damage or embolic risks.<\/p>\n<p>Effective treatment of infective endocarditis involves antibiotics tailored to the causative bacteria, addressing heart failure symptoms, and, if necessary, valve repair or replacement. Prevention hinges on good oral hygiene and overall healthy lifestyle choices, including exercise. Advances in prosthetic valves improve outcomes and longevity of valve replacement procedures.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"author":1370,"menu_order":30,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":["zoe-soon"],"pb_section_license":"cc-by-nc-sa"},"chapter-type":[],"contributor":[60],"license":[57],"class_list":["post-5634","chapter","type-chapter","status-web-only","hentry","contributor-zoe-soon","license-cc-by-nc-sa"],"part":55,"_links":{"self":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/5634","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/users\/1370"}],"version-history":[{"count":5,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/5634\/revisions"}],"predecessor-version":[{"id":5639,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/5634\/revisions\/5639"}],"part":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/parts\/55"}],"metadata":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/5634\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/media?parent=5634"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapter-type?post=5634"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/contributor?post=5634"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/license?post=5634"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}