_🔹ENDOCARDITIS_ ▪️Endocarditis is an inflammation of the inner layer of the heart. ▪️It is usually caused by bacteria, fungi, or viruses entering the bloodstream through invasive procedures like dental work or surgery. ▪️The microbes accumulate on the heart valves, forming vegetations that can damage the valves over time. _🔹CAUSES_ *_(a)Bacteria._* ▪️Streptococcus viridan. ▪️Staphylococcus Aureus. _*(b)Fungi*_ ▪️Aspagellus ▪️Candida *_(c).Acute rheumatic fever which causes enlarged and tender lymph nodes,damages the valves._* _*(d).Congenital heart disease.*_ _🔹RISK FACTORS_ ▪️Previous heart damage. ▪️Heart surgeries. ▪️Dental surgeries can introduce bacterias. ▪️Long term haemodialysis. ▪️Diabetes Mellitus. *_🔹TYPES_* _*(I)ACUTE ENDOCARDITIS*_ ▪️Infections caused by staphylococcus Aureus occurs rapidly on normal valves. _*(II)SUBACUTE ENDOCARDITIS*_ ▪️This is infection caused by streptococcus viridans and usually develops gradual on previously damaged heart valves e.g. rheumatic heart disease. *_(III)POST OPERATIVE ENDOCARDITIS_* ▪️ Infection following cardiac surgery in which prosthetic heart valves are used. ▪️ It is caused by staphylococcus. *_🔹PATHOPHYSIOLOGY_* ▪️A deformity or injury of the endocardium leads to accumulation fibrin and platelets (clot formation). ▪️The infection most frequently results in platelets,fibrin,blood cells,and microorganisms that clusteras vegetations on the endocardium. ▪️The vegetations may embolize to other tissues throughout the body. ▪️As the clot on the endocardium continues to expand,the infecting organism is covered by the new clot and concealed from the body's normal defenses. ▪️The infection may erode through the endocardium into the underlying structures(eg,valve leaflets),causing tears or other deformities of valve leaflets,dehiscence of prosthetic valves, deformity of the chordae tendineae,or mural abscesses. ▪️Usually the onset of infective endocarditis is insidious. ▪️The signs and symptoms develop from the toxic effect of the infection,from destruction of the heart valves,and from embolization of fragments of vegetative growths on the heart. ▪️Systemic emboli occur with lef-sided heart infective endocardis;pulmonary emboli occur with right-sided heart infective endocarditis. _OR_ ▪️The endocardium is invaded by microbes directly. ▪️The microbes cause deformity, thickening, stiffening and scaring of the valve leaflets and may travel to other organs and obstruct blood flow. ▪️ This results in valvular incompetence and invasion of the myocardium by infection resulting myocardial dysfunction, sepsis and congestive cardiac failure. _🔹CLINICAL FEATURES_ ▪️Fever. ▪️Tachycardia ▪️Petechiae conjunctiva. ▪️Splinter hemorrhages in nail beds. ▪️Osler's nodes -painful red nodes on pads of fingers and toes; usually late sign of infection and found with a sub acute infection. ▪️Murmurs with other signs and symptoms may indicate right side heart infection. ▪️Tachycardia related to decreased cardiac output. ▪️Localized headaches. ▪️Transient cerebral ischemia. ▪️ Altered mental status, aphasia. ▪️Hemiplegia. ▪️ Cortical sensory loss ▪️Haemoptysis. ▪️Chest pain, shortness of breath. ▪️Kidney --haematuria. ▪️Spleen- pain in left upper quadrant of abdomen radiating to left shoulder. _🔹DIAGNOSTIC EVALUATIONS_ ▪️Blood cultures for isolation of the causative organism. ▪️Echocardiogram for identification of infected area. ▪️ Blood for white cell count and erythrocyte sedimentation rate which show elevated levels. ▪️CXR to detect cardiomegaly. ▪️Urinalysis to see microscopic hematuria. ▪️Computerized tomography rule out heart damage ▪️Review bun and creatinine levels to evaluate renal function. ▪️Review endocardiography finding if available for valvuler and ventricular function and presence of vegetation. _🔹MANAGEMENT_ *_Native valve endocarditis_* ▪️Benzylpenicilin 5MU 6 hourly 2- 6 weeks. ▪️Paeds dose:0.05-0.1MU/kg ▪️ Gentamycin 80-120mg IV 12 hourly for 2 weeks. ▪️Paeds dose: 1-1.5 mg/kg. ▪️Ceftriaxone 1g IV 12hrly for 2-6 weeks. ▪️Paeds dose:50mg/kg *_Prosthetic valve endocarditis_* ▪️Cloxacillin 2g 6hrly for 4-6 weeks. ▪️Paeds dose:15mg/kg ▪️Gentamycin 80-120mg 12hrly for 4 weeks. ▪️Paeds dose:1-1.5mg/kg *_Treatment of culture positive endocarditis_* ▪️Benzylpenicilin 5MU IV 6hrly for 4-6 weeks. ▪️Gentamycin 80-120mg 12hrly for 4 weeks. _🔹COMPLICATIONS_ ▪️Valvular heart disease. ▪️ Heart failure. ▪️Myocarditis.