Infective endocarditis is a microbial infection of the endothelial or the innermost layer of the heart which chambers the heart which are biologically of the same genetic makeup of endothelial cells which primarily compose the cells lining all blood vessels. Basically, the endocardium functions as the protective layer of the valves of the heart and its underlying chambers.
Infective endocarditis is a common disease that commonly affects older people who are likely to have more degenerative lesions affecting the valves of the heart which results in a reduced immune response to infection and the metabolic alterations associated with the normal ageing process. Infective endocarditis of Staphylococcal in origin (infection of the valves on the right side of the heart) is common among injection drug dependents. Moreover, hospital-acquired infections that cause endocarditis occur most often in patients with debilitating disease or afflicted with indwelling catheters and in patients who are receiving prolonged intravenous fluid or antibiotic therapy.
Pathophysiology of infective endocarditis
Infective endocarditis occurs when there is a deformity or injury of the endocardium which leads to acute accumulation on the endocardium of exudates of the immune response such as fibrin platelets and clot formation. Infectious organisms usually streptococci, pneumococcal and staphylococci invade the clot and endocardial lesions paving way to the infection of the endocardial layer of the heart. Another causative microorganism includes fungi such as Aspergillus and Candida.
The infection most commonly results from blood cells platelets and fibrin and other microorganisms that huddle up on the endocardial layer of the heart. These clustered microorganisms embolize to the other tissues throughout the body. As to the clot on the endocardium, it insidiously expands leading to infection which is covered by new clot formation concealing the body’s normal immune response. Normally, the onset of infective endocarditis is insidiously progressive. The signs and symptoms develop from the toxic effect of the infection, from the destruction of the heart valves and from embolization fragments of the clustering of the exudates.
Clinical manifestations of infective endocarditis
The primary presenting symptoms of infective endocarditis are heart murmurs and low-grade fever. The fever may be intermittent or generally absent in some rare cases, especially in patients who are receiving corticosteroids and antibiotics, the elderly or those individuals with end stage renal failure and heart failure. Murmurs that worsen over time indicate progressive damage and/or perforation of the valves. In addition to fever and heart murmurs, clustering of petichiae may manifest itself on the body. Small, painful nodules may be present in the pads of the toes and fingers. Also, in rare occasions there can be splinter hemorrhage that can be seen under the toenails and fingernails and petichae may also appear in the mucous membranes and conjunctiva. Furthermore, complications such as enlargement of the heart and spleen, increased heart rate and heart failure may be present in infective endocarditis.
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Although the previously described characteristics may be indicative of infective endocarditis, the signs and symptoms are not specific to the infective disease but may also point out other diseases as well. Although quite rare, bacterial endocarditis may be seriously life-threatening, the key strategy in treating this disease is prevention in moderate and high-risk individuals. Treatment options for the acute phase of this condition basically include pharmacological therapy and surgical management in adjunct to nursing care such as compliance with medication, promoting adequate rest and comfort.