Pathophysiology - Theoretical Base Infective Endocarditis

Modifiable factors
modifiable factors
Heart Diseases
than 50 years old
Impaired Host Defence
Gender- more prevalent with males
Intravenous drug abuse
Common activities- Everyday activities such as brushing
teeth or chewing food can allow bacteria to enter your
bloodstream especially if teeth and gums are in poor condition
Some medical conditions- like skin sore or intestinal disorder
like inflammatory bowel disease may give bacteria the
opportunity to enter the bloodstream
Cathethers or needles- bacteria can enter body through
Contaminated invasive equipments
Dental or Respiratory tract procedures- If aseptic technique
is not properly utilize it may allow bacteria to enter
bloodstream
With pacemakers- favorable environment for thrombus
Formation

NonAge- more

Entry of microorganism through portal of entry

Circulating bacteria are lodged much more

haemodynamic stress
frequently on previously damaged valves
to cause damage to the
from disease like CHD or RHD than healthy
the formation platelet
valves
infected from circulating

Conditions producing
on the valves are liable
endocardium, favouring
thrombi which gets
bacteria

inflammation of inner layer of heart or endocardium

may involve heart valves, interventricular septum, chordae tendinae
valves of the heart do not receive any dedicated blood supply
defensive immune mechanism

White Blood Cell

Do not reach the valves via blood stream
The host immune response is blunted
Vegetation
Consist of platelet, fibrin, microcolonies of microorganism,
scanty inflammatory cell

Acute bacterial endocarditis

Subacute bacterial endocarditis

fulminant and obstructive acute infection

in a previously
of the endocardium by highly virulent bacteria
gradual down hill
in a previously normal heart (fatal 2-6 weeks)
to years

caused by less virulent bacteria

diseased heart and has a
course in a period of six weeks

Infective agents: staphylococcus aureusIVDA,

Infective agents:
streptococcus viridians(mouth)
pneumococci, gonococci, Beta-streptococci,
streptococcus bovis(stomach),
streptococcus
enterococci
pneumonia, staphylococcus
epidermidis

integral binding of antibody

to a soluble antigen
immune complex
spots

retinal haemorrhages with pale centers

septic emboli with bacteria

splinter hemorrhage
forms microabscesses
inflammatory response

fingers

damage to capillaries

roths

swelling
redness
macule/flat lesion

pain

osler nodes found on hands and feet

lesion non-tender

erythematous
janeway lesion