Lecture Notes: Infective Endocarditis & Rheumatic Fever

Introduction

• Presenter: Cathy from Level Up RN
• Topics: Infective Endocarditis and Rheumatic Fever
• Resources: Level Up RN Pediatric Nursing Flashcards
• Quiz: A quiz will be provided at the end to test key points.

Infective Endocarditis

Definition

• Infection of the inner layer of the heart (endocardium)
• Etymology: "Endo" (inside/inner), "card" (heart), "itis" (inflammation)

Pathophysiology

• Bacteria adhere to heart, forming vegetative growths on heart valves/endocardium

Signs and Symptoms

• Fever, malaise, lethargy
• Loss of appetite
• Splinter hemorrhages (blood spots under fingernails)
• Petechiae (red dots under the skin)
• Heart murmur
• Muscle and joint pain

Diagnosis

• Echocardiogram
• Blood cultures
• Elevated ESR (Erythrocyte Sedimentation Rate) and CRP (C-reactive protein) indicating inflammation

Treatment

• IV antibiotic therapy (2-6 weeks) via PICC line
• Possible valve repair/replacement if valve damage occurs
• Family teaching includes prophylactic antibiotics before dental/invasive procedures

Rheumatic Fever

Definition

• Inflammatory disorder affecting heart, blood vessels, and joints

Pathophysiology

• Abnormal immune response to group A beta-hemolytic Streptococcus (GABHS) infection
• Leads to widespread inflammation and potential long-term cardiac damage (rheumatic heart disease)

Key Risk Factor

• Untreated or partially treated strep throat infection can lead to rheumatic fever

Diagnostics

• Throat culture positive for GABHS
• Positive Antistreptolysin O (ASO) titer indicating antibodies to GABHS
• Elevated ESR and CRP levels indicating inflammation
• Jones Criteria for diagnosis: 2 major or 1 major + 2 minor criteria

Major Criteria (Jones)

• Carditis: Inflammation of the heart (murmurs, pericardial friction rub, cardiomegaly, arrhythmias, CHF)
• Polyarthritis: Painful swelling of large joints
• Erythema Marginatum: Non-pruritic rash on trunk/limbs
• Chorea: Involuntary muscle movements
• Subcutaneous Nodules: Non-tender bumps under skin

Minor Criteria

• Fever
• Arthralgia (joint pain)
• Elevated ESR or CRP
• Prolonged PR interval on EKG

Treatment

• Long-term penicillin administration
• Bed rest

Quiz Questions

1. What is the key risk factor in the development of rheumatic fever?
   • Answer: Untreated/partially treated GABHS infection
2. What key symptom of rheumatic fever is characterized by involuntary muscle movements?
   • Answer: Chorea
3. What EKG abnormality may be caused by rheumatic fever?
   • Answer: Prolonged PR interval

Conclusion

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