التهاب الشغاف العدوائي

Definition

Infective endocarditis is infection of the inner lining of the heart, usually on the valves, forming vegetations of bacteria, platelets and fibrin.

Risk factors

• A prosthetic or previously damaged valve
• Injecting drug use (often the tricuspid valve)
• Central venous catheters, haemodialysis and previous endocarditis

Symptoms and signs

• Fever, fatigue and weight loss
• A new murmur or a change in an old one
• Splinter haemorrhages, tender finger-pad nodules (Osler) and painless palm spots (Janeway)
• Embolic signs: stroke, flank pain or a cold limb

Diagnosis

Three sets of blood cultures from different sites before antibiotics, and echocardiography, preferably transoesophageal.

Treatment

• IV antibiotics, usually for 4–6 weeks
• Valve surgery for heart failure, abscess or recurrent emboli

Nursing care

• Care of the long-term line (PICC) during treatment
• Watch for heart failure, stroke and embolic events
• Teach dental care and prophylaxis before procedures for high-risk clients

Exam point

Fever with a new murmur in someone who injects drugs or has a prosthetic valve is endocarditis until proven otherwise, and cultures come before antibiotics.