Endocarditis Practice Questions with Answers and NCLEX® Review

Introduction to Endocarditis

Endocarditis is a condition in which bacteria or fungi get into the inner lining of the heart. The infection can occur in any part of the heart and can cause serious damage to heart valves.

Endocarditis is caused by inflammation and potentially leads to damage to the heart valve. It can also be caused by bacteria entering the bloodstream through cuts or other breaks in the skin, such as pimples or cuts on hands.

Risk factors for endocarditis include:

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• Open heart surgery
• Infections affecting the heart or blood vessels
• Rheumatic fever
• Other conditions that affect the immune system

Endocarditis Pathophysiology

The endocardium is a thin, smooth tissue that makes up the lining of the chambers and valves of the heart. The innermost layer of the heart’s walls serves as a barrier between cardiac muscles and the bloodstream and holds necessary blood vessels in place. It also contains the heart’s conduction system, which regulates the activity of cardiac muscles. 

Endocarditis occurs when bacteria and germs can enter the bloodstream and travel to the heart. The germs then stick to damaged heart valves or damaged heart tissue. Endocarditis is a life-threatening inflammation of the inner lining of the heart’s chambers and valves.

Memory trick:

Inflammation is INside the heart

Endocarditis Signs and Symptoms

Signs and symptoms of endocarditis can be memorized with this acronym:

• Clots in the heart & brain
  • Risk for stroke CVA – monitor for “agitation” “change in level of consciousness”
  • Splinter hemorrhages (clots under fingernails)
• Lung fluid (crackles)
• Overheated (fever)
• Too little Oxygen (low cardiac output)
  • • Clubbing fingers

Endocarditis Causes

Causes of endocarditis include:

• Bacteria in the bloodstream (bacteremia)
  • Dirty needles
  • Infection from a dental procedure or surgery on your mouth or gums
• Congenital abnormalities in your heart (like a valve with an abnormal flap) that can allow bacteria to enter
• Faulty prosthetic heart valves (which can put the client at risk for bacteria to enter the heart resulting in an infection)
• Untreated strep throat

Endocarditis Treatment

Endocarditis treatments vary depending on the cause of the infection and how severe it is. Some treatments include:

• Antibiotics 
• Surgery (to remove damaged tissue from the heart)
• Valve repair or replacement

Pericarditis Pathophysiology

Pericarditis is a condition that affects the pericardium, or the inner lining of the heart. Pericarditis occurs when there’s an infection or inflammation of the pericardium, which is the sac that encases your heart and holds it in place. This sac contains fluid to protect your heart from injury and trauma, as well as blood vessels that bring blood to and from the heart muscle. 

Pericarditis Signs and Symptoms + Labs

• Precordial chest pain
• Elevated WBC (over 10,000)
• Elevated C-reactive protein (CRP)
• Cardiac Tamponade
  •  1. JVD
  •  2. Muffled heart sounds
  •  3. Pulsus paradoxus
    • (drop in sys. BP by 10 mmHg)

Causes of Pericarditis

Pericarditis causes include:

• Viruses (Epstein-Barr, cytomegalovirus, coxsackie B virus)
• Heart valve problems
• Bacteria (streptococcus and salmonella)
• Other infections (tuberculosis)
• Heart or renal failure
• Autoimmune diseases (rheumatoid arthritis)
• Chest injuries

Memory trick:

• Heart attack
• Autoimmune disorders
• Infection
• Renal failure

Pericarditis Treatment

If treatment is unsuccessful, then surgery may be needed to drain fluid from around the client’s heart or remove damaged tissue from the heart muscle:

• NSAIDS (indomethacin)
• Steroids (prednisone)
• Pericardiocentesis (needle in the heart) to drain any fluid or blood in the heart sac
• Corticosteroids 
• Antibiotics (penicillin or doxycycline)

Sources

https://pubmed.ncbi.nlm.nih.gov/4014276/ 

https://www.mayoclinic.org/diseases-conditions/endocarditis/symptoms-causes/syc-20352576 

https://www.merckmanuals.com/professional/cardiovascular-disorders/myocarditis-and-pericarditis/pericarditis 

https://my.clevelandclinic.org/health/diseases/17353-pericarditis