Infective Endocarditis

WHAT YOU SHOULD KNOW:

• The endocardium is a thin layer of tissue that lines the inside of your heart. It covers the walls of your heart chambers (rooms), and your heart valves. Your heart valves act as one-way doors to direct the flow of blood through the heart. Infective endocarditis occurs when this lining becomes infected. The infection causes inflammation of the endocardium. Bacteria are the germs that most commonly cause infective endocarditis. Bacteria get into your body in different ways, such as during surgery, dental care, or injecting street drugs. Health problems, such as heart and immune system problems, may increase your risk of endocarditis.
  
  
• With endocarditis, you may feel weak, have a fever, feel tired, or have body soreness. With a more serious case of endocarditis, you may be very sick and unable to care for yourself. You may need to stay in the hospital for tests and treatment. Tests you may need include lab tests, x-rays and scans, and other heart and lung tests. Medicines for your heart, blood pressure, and infection may help you get better. You may need other treatments, depending on the problems your endocarditis has caused.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

Infective endocarditis and the health problems it may cause can be serious, even life threatening. Your risks of long-term problems decrease with early treatment. Even with treatment, your symptoms may come back. Certain heart problems may increase your risk of getting endocarditis again. Having had endocarditis in the past increases your risk of getting endocarditis again. Ask your caregiver if you need to take antibiotic medicine before certain dental and medical procedures to help prevent this.

WHILE YOU ARE HERE:

Activity:

You may need to rest in bed until your heart problem is under control. Your caregiver will tell you when it is OK to get out of bed. Call your caregiver before getting up for the first time. If you feel weak or dizzy, sit or lie down right away and call your caregiver.

Call button:

You may use the call button when you need your caregiver. Pain, trouble breathing, or wanting to get out of bed are good reasons to call. The call button should always be close enough for you to reach it.

Day/night confusion:

If you stay in an intensive care unit (ICU), you may not know when it is daytime or nighttime. This is common for patients staying in ICU. Having the lights on all the time can cause it. The lights may cause you to feel or act confused. When you are moved to a room on a regular floor, you will become more aware of time.

Informed consent

is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

Monitoring:

Caregivers may use one or more of the following to keep track of how you are doing.

• Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
  
  
• Intake and output: Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.
  
  
• Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
  
  
• Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.
  
  
• Weight: You may be weighed each day. Caregivers compare your weight from day to day to record how much body fluid you have. You can become dehydrated if you lose too much. You can have shortness of breath or swelling in your legs if you retain too much.

Tests:

Samples of your blood and urine may need to be collected for tests. You also may need one or more of the following tests. The results of these tests help caregivers plan the best way to treat you.

• Echocardiogram: This test is a type of ultrasound. Sound waves are used to show the structure, movement, and blood vessels of your heart.
  
  
• Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
  
  
• CT scan: This test is also called a CAT scan. A special x-ray machine uses a computer to take pictures of your body. Your caregivers look at the pictures to check for problems in your body. Before taking the pictures, you may be given dye through an IV in your vein. The dye helps blood flow show up better in the pictures.
  
  
• MRI: This test is also called magnetic resonance imaging. During the MRI, pictures may be taken of your heart or other parts of your body. Caregivers use these pictures to look for certain heart problems, such as bacteria growing on the heart valves.
  
  
• Transesophageal echocardiogram (TEE): A transesophageal echocardiogram is a type of ultrasound that shows pictures of the size and shape of your heart. It also looks at how your heart moves when it is beating. These pictures are seen on a TV-like screen. You may need a TEE if your heart does not show up very well in a regular echocardiogram. You may also need a TEE to check for certain problems such as growths on the heart valves.
  
  
• Cardiac catheterization: This is a procedure done to find the cause of and treat a heart condition. A thin, bendable tube inserted into an arm, neck, or groin vein is moved into your heart. Your caregiver may use an x-ray to guide the tube to the right place. Dye (contrast) may be put into your vein so the pictures show up better on a monitor.

Treatment options:

Your treatment may change if your heart problem is not being controlled. This is often decided after you have tests. You may have some of the following treatments alone or together.

• An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Oxygen: You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.
  
  
• Surgery: You may need to have a valve in your heart repaired or replaced after the infection is under control.

Medicines:

• Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
  
  
• Blood pressure medicine: This is given to lower your blood pressure. A controlled blood pressure helps protect your organs, such as your heart, lungs, brain, and kidneys. Take your blood pressure medicine exactly as directed.
  
  
• Diuretics: This medicine is given to decrease edema (excess fluid) that collects in a part of your body, such as your legs. Diuretics can also remove excess fluid from around your heart or lungs and decrease your blood pressure. It is often called water pills. You may urinate more often when you take this medicine.
  
  
• Heart medicine: This medicine is given to strengthen or regulate your heartbeat. It also may help your heart in other ways. Talk with your caregiver to find out what your heart medicine is and why you are taking it.
  
  
• Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
  
  
  • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
    
    
  • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.

Learn more about Infective Endocarditis (Inpatient Care)