 Hi, welcome to the Sink School Explained and this video on endocarditis. Let's first look at the anatomy of the heart and the different layers that we have. So in the center, the innermost layer of the heart that includes the heart valves here in green is called the endocardium. The muscle around it, that's the actual meaty part of the heart, is the myocardium, the myo-meaning muscle, and then the pericardium is the area that surrounds the heart, peri-around-the-heart, where we have some pericardial fluid that helps to lubricate the heart when it contracts and expands to make sure that there's no rubbing of the different layers here. So in endocarditis, knowing that is the innermost layer of the heart and includes the heart valves, we know that now we have inflammation of the inner lining of the heart. And that is typically caused from staph infections such as staph aureus or staph viridens that can infect previously damaged valves. That then forms vegetations, which basically is like a vegetable growing on the valve that consists of primary lesions, fibrin, leukocytes, platelets, and microbes that then stick to the valves preventing it from opening and closing effectively. Now, if these vegetations break off, they can form an embolus. If they break off from the left side of the heart, they'll shoot straight out to the body and then they can get lodged in the brain, the kidneys, the limbs, or really any other organ. And if they come off the right side of the heart, they would be dislodged into the lungs causing a pulmonary embolus. Now, complications from endocarditis includes dysrhythmias. The connective tissue of the heart, so the different electrical conduction system parts, lie very close underneath the heart valves. So now if we have inflammation of the valves, it can directly affect the conduction system therefore leading to dysrhythmias. If the valves are so dysfunctional that they are stenosed meaning that they can't open or they have regurgitation meaning the blood flow kind of flows back and forth, it can lead to heart failure. And because we have a strep infection, it can lead to sepsis and therefore also heart blocks because of the closeness to the underlying connective tissue of the heart. Now, risk factors for endocarditis include cardiac conditions such as prior endocarditis puts you at higher risk. Any prosthetic heart valves, a quiet valve disorders such as aortic stenosis and mitral regurgitation as happens in a lot of our older population. Continental heart defects, so any abnormal defects that patients are born with such as ventricular septal defect. A pacemaker insertion puts you at higher risk as well as history of cardiomyopathy and Marfan syndrome. Now, non-cardiac conditions that can lead to endocarditis include hospital acquired bacteremia. So that's basically sepsis resulting from any other organ systems such as pneumonia, UTI or some of those common ones. And also IV drug abuse puts the patient's higher risk for endocarditis because through the use of contaminated needles, the staff could be injected through the bloodstream and then these vegetations form from the bacteria on the heart valves. And procedures, certain procedures also can cause endocarditis and that would be a central line insertion, for example. So if it's not a sterile procedure, it can cause that problem. If a patient is diagnosed with endocarditis, they'll sometimes have very kind of vague symptoms because we can't really see what's going on. So they'll have general malaise, fever and chills. They'll feel fatigued and anorexic. They'll have muscle and joint aches, atheralgia and myalgia. They might have weight loss, headaches and clubbing. And then there are a few things that are very specific to endocarditis, the assessment findings. First of all are splinter hemorrhages and that's exactly what it sounds like. It's like a splinter underneath the finger bed, which are from these microemboli that break off and then get lodged in the small capillaries of the fingertips. So you will see these hemorrhages underneath finger beds. And then they can also get petechiae from microclots that build underneath the skin. And then there can be Osler's nodes, which form on the fingers and toes. And Osler's nodes are kind of painful, tender, red, purple, pea-sized lesions, again from these microclots. Janeway lesions, which are flat, painless, small red spots, again on the fingertips, on the toes, the soles and the palms. And then because the vegetations affect the flow of the blood through the valves, a murmur is probably audible. And aortic and mitral again are most common. And then if an embolus breaks off to the kidney or spleen, the patients can have flanked pain or tenderness, or they might have blood in the urine or any kind of kidney dysfunction that we can measure in their blood. Now for diagnostic procedures, what puts the patient at higher risk is recent dental, urologic, gynecological, or any cardiac procedures. History of IV drug abuse, like we discussed, any history of heart disease or valve disorders. And so for diagnostic tests, we would do blood cultures. And a lot of times they do three rather than just two blood cultures. Certainly you want to look at the CBC, especially white count, CMP for chemistry, check in electrolytes, kidney liver function. And then inflammatory markers because we're dealing with an ITIS, ITIS here. So we want to check inflammatory markers, ESR and CRP, as well as check the heart. Look at the valves with an echocardiogram, see if it's been affected from the conduction system point by checking an EKG. And then looking at a chest x-ray, seeing if it's leading to heart failure here. Now treatment for endocarditis because it is an infection with a bacteria. It is treated with antibiotics and it's usually a long-term treatment. This might mean four to six weeks of IV antibiotics. So the patient might go home with home health so they can complete that long course of antibiotics. If they're initially diagnosed, most definitely they will need admission to the hospital for close observation. And the heart failure symptoms will have to be managed if they occur. So with diuretics, ACE inhibitors, positive inotropes such as digoxin. And then if the patient gets over the spout of endocarditis, as we learned here prior, endocarditis is a risk factor. So for any invasive procedures, they will need prophylactic antibiotics. And they usually include procedures for oral and dental procedures. So anything that involves the gums or the roots or any kind of puncture of the skin there. Any respiratory procedures such as lung biopsies or surgical procedures of infected skin or muscle. So an abscess, incision and drainage or treatment for osteomyelitis. And patients with prosthetic heart valves, history of endocarditis. Any kind of congenital heart disease and heart transplant will also need the prophylactic antibiotics. Thanks for watching this video on endocarditis. Please check out the other videos that address myocarditis and pericarditis as well. And I'll see you soon here on Nursing School Explained.