Case Study 15: Endocarditis Essay

No history of skin disease. Skin is pink, dry, and void of bruising, rashes, or lesions. No recent hair loss; head is normocephalic. Pupils equally reactive to light; no history of glaucoma or cataracts. Ears are in normal alignment; no history of chronic infections, hearing loss, tinnitus, or discharge. Nose and sinus history includes clear nasal discharge “since last October”, and occasional nose bleeds; states she use to get nose bleeds often as a child. Mouth and throat are absent of lesions; no bleeding gums, sore throat, dysphagia, hoarseness, or altered taste. Neck is void of pain, swelling,

Aortic Dissection: She doesn’t experience from this condition because she doesn’t have sever hypertension and absent peripheral pulses. Also, she doesn’t have a wide mediastinum with extension of the aortic wall beyond the calcific border.

The underlying cause of this condition is heart failure. It may happen suddenly (acute) or gradually over time as many traumas or attacks damage the heart. Common acute causes of cardiogenic shock include:

For many patients, surgery is performed on the damaged valves. Surgery types differ for each individual depending upon which valves were affected, how severely they were infected, and if valves had previously been replaced artificially. Before surgery, patients must undergo a series of strenuous tests and careful assessments to be sure he or she qualifies for surgery. In a particular study, several patients were able to undergo valve replacement surgery.

Myocarditis is a very difficult disease to treat and to properly diagnose. The disease is symptomatic in some patients and asymptomatic in others. Myocarditis is one of the proposed mechanisms of sudden athlete death (SAD). Cardiovascular diseases are the number one cause of morbidity and mortality in western societies. Myocarditis is an inflammatory heart disease that may be caused by different pathogens and triggers; it is gaining increasing importance because of its links to sudden death syndrome in young athlete, and to dilated cardiomyopathy (Yilmaz et al., 2012). There are many proposed causes of sudden athlete death; one of the primary causes is hypertrophic cardiomyopathy (HCM). As with any disease we should investigate all factors influencing its pathology including but not limited to: genetic, cultural, and environmental factors. Hypertrophic cardiomyopathy is a heritable disease that is typically passed down as an autosomal dominant trait; only one copy of the dominant allele is required to display the effected phenotype.

Pneumonia or fluid in pleural space: assess the chest and lungs for breath sounds, respiratory effort, and signs of distress. Impaired tissue perfusion: check pulse ox, capillary refill, extremity warmth, pedal pulses, LOC, and urine output. Reduced urine output is a sign of decreased cardiac

When a patient’s heart has a defect or a part that is not as strong as the rest then that part is susceptible to infective endocarditis. This tends to come from blood flowing from a higher pressure area in the heart to a lower pressured area. This causes an ‘indention’ in the heart’s endocardium that collects deposits. When patients have bacteremia, the presence of infectious bacteria in the blood, the bacteria often fall into these ‘indentions’ and start to collect. Once they have started to collect they will multiply and are called vegetation.

Necropsy studies of patients with right-sided infective endocarditis and of opiate addicts have shown that vegetation was ten times more common in the tricuspid valve than in the pulmonary valve. The involved valves were nearly always anatomically normal before the onset of the cardiac infection.the survival of patients with congenital heart disease has increased the number and age of the population susceptible to infective endocarditis. Formerly, the patients most susceptible to infective endocarditis were those with tetralogy of Fallot, patent ductus arteriosus and ventricular septal defect. Congenital and acquired valve deformities play an important role in the pathogenesis of the infection and are responsible for the increase of infective endocarditis in adults [3]. Vegetations usually develop on the low-pressure side of the defect with endocardial trauma, and downstream from the site of the lesions.In patients with patent ductus arteriosus, the vegetations first develop at the pulmonary end of

The term myocarditis has been around since the beginning of the twentieth century (Dennert et al., 2008). It was during this time that the discovery of coronary artery disease was gaining recognition, the term itself however fell out of circulation (Dennert et al., 2008). In 1987 a new classification to diagnose myocarditis was introduced, it was the Dallas classification (Dennert et al., 2008). It was meant to create a standard for diagnosing but unfortunately it was not a perfect method, there were some key faults (Dennert et al., 2008). The Dallas classification did not account for sampling error, and most notably it allowed for variation in pathological interpretation (Dennert et al., 2008). Presently it is not used as a stand alone method,

The pericardium, is a double-layered, closed sac that surrounds the heart. It consists of a tough fibrous connective tissue outer layer known as fibrous pericardium. The thin, transparent, inner layer called the serous pericardium, contains two inner layers. The lining of the fibrous pericardium called the parietal pericardium and usually measures 2mm in thickness. The layer lining the heart organ is known as visceral pericardium; also the epicardium. And the cavity between the parietal and visceral pericardium, filled with serous pericardial fluid,that helps reduce friction as the heart contracts.

Tachycardia refers to an abnormally fast resting heart rate - usually at least 100 beats per minute. The threshold of a normal heart rate (pulse) is generally based on the person's age. Tachycardia can be dangerous; depending on how hard the heart has to work.In general, the adult resting heart beats between 60 and 100 times per minute (some doctors place the healthy limit at 90, so some of them may diagnose tachycardia at slightly lower than 100 beats per minute). When an individual has tachycardia the upper or lower chambers of the heart beat significantly faster - sometimes this happens to both chambers.

Classifications of aortic stenosis is often based on factors that include its opening area and the pressure related to it. These are often derived from the echocardiography recordings the change in the relation between the mean opening areas to the pressure gradients provides insights about the severity of the disease in terms of its effect on the left ventricle increased load.

There are many viruses that are connected to myocarditis including; the common cold, herpes simplex, and hepatitis B & C. The next potential cause is bacteria. There are a few commonly known bacteria that are linked to myocarditis, a few of which include: streptococcus and staphylococcus. Another potential cause of myocarditis is parasites. Some of these parasites are transmitted by insects. This cause is more prevalent in Central and South America but it can occur in travellers. The final potential cause is fungi. In people with weakened immune systems, yeast infections, molds, and other fungi can cause myocarditis. In addition to these causes, there are some behaviors that could also spur myocarditis along. These include: medications, illegal drugs, radiation, chemical, and lupus. There are many symptoms that could help identify myocarditis, including (but not limited to): fatigue, shortness of breath, arrhythmias, chest pain, body aches, headaches, fever, or a sore

Infective endocarditis is an infection of microorganisms, whether it be bacterial or viral, which form colonies within the endothelial lining of the heart tissue. This initiates an immune response that causes the infected sites to grow. Figure 1 8 shows vegetations on the aortic valve which prevent it from functioning properly. Without the ability to fully seal during diastole, blood is pulled back through the aortic valve from the aorta. This disrupts the pressure in the left ventricle in such a way that creates unnecessary stress on the muscle. Infective endocarditis that is present on the right side of the heart (including the aortic valve) is of highest incidence within the population of recreational intravenous drug users at 46% - 78% of reported cases. 9 The risk of infective endocarditis causing vegetation on and around the aortic valve increases after valve replacement surgery. A study done in Australia observed 2443 aortic valve replacement surgeries, taking into consideration their pre-and-post-operation condition. Of said patients, 3.7% developed infective endocarditis. All valve prostheses were either of allograft (human), xenograft (porcine, bovine, or equine), or mechanical design (composite synthetics), the xenograft being the most popular.

The symptoms of problems with the aortic valve are similar to that of a heart attack. There is chest pain and pressure that some describe as feeling like the heart is being squeezed. The heart might also have a sensation of fullness that seems different, and the left arm might also go numb. Some of the other symptoms include: