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Endocarditis for the Correctional Nurse

Infective endocarditis is an infection of the lining of the heart (endocardium) and often involves the valves of the heart as well as any areas with abnormal connections between the chambers of the heart or its blood vessels.  It occurs when bacteria in the bloodstream clump on previously injured heart valves. Risk factors for endocarditis include injection drug use; compromised immune system; congenital heart defects; having a prosthetic (artificial) heart valve, pacemaker, or defibrillator; and deteriorated heart valves due to the aging process.   Acute bacterial endocarditis usually begins suddenly with a high fever, tachycardia, and fatigue.  Rapid and extensive heart valve damage occurs as a result.

Subacute bacterial endocarditis occurs gradually, causing symptoms like fatigue, low-grade fever, tachycardia, weight loss, diaphoresis, and anemia. Diagnostic tests for endocarditis include echocardiography to detect the damaged heart valves, a complete blood count, and blood cultures to identify the bacteria causing the infection.  Treatments include high doses of antibiotics that are given intravenously, but sometimes surgery is needed to repair or replace damaged heart valves.  Infective endocarditis affects twice as many men as women in all age groups. More than 25% of all cases occur in individuals over 60 years old.

Non-infective endocarditis occurs when blood clots that do not have bacterial contamination form on the heart valves and endocardium.  It can progress to infective endocarditis if bacteria enter the bloodstream and attaches to the clots.  In both infective and non-infective endocarditis blood clots can break free from the endocardium and heart valves, causing blockage of the arteries at major organs and stroke.

In this class, we will review the pathophysiology of infective and non-infective endocarditis.  We will discuss risk factors and treatment.  We will also review the nursing interventions for a patient with endocarditis.