Endocarditis
Endocarditis is an inflammation of the heart's lining. The most common type, bacterial endocarditis, happens when germs enter your heart. These germs come through the bloodstream from another part of the body, often the mouth. Bacterial endocarditis can damage your heart valves. If untreated, it can be life threatening. It is rare in healthy hearts. Risk factors include having: - An abnormal or damaged heart valve - A severe case of mitral valve prolapse - An artificial heart valve - Certain heart defects If you have a high risk of bacterial endocarditis, your doctor might prescribe antibiotics before dental work, surgery, or invasive medical procedures. Early treatment can help you avoid complications. Symptoms you might notice include fever, shortness of breath, fluid buildup in your arms or legs, tiny red spots on your skin, and weight loss. Treatment usually involves high-dose antibiotics.
Introduction:
Endocarditis is an inflammation of the heart’s inner lining. This lining is called the endocardium. The condition is also called infective endocarditis, or IE. The term “endocarditis” is also used to describe an inflammation of the endocardium due to other conditions. This program focuses on endocarditis related to infection. Endocarditis can damage the valves in the heart. If left untreated, it can be life threatening. Endocarditis is rare in healthy hearts. This program explains endocarditis. It covers symptoms, causes, diagnosis, and treatment.
The Endocardium:
The endocardium is the inner lining of the heart. The heart pumps blood to the lungs and to the rest of the body. The endocardium includes fibers that are important to synchronize the beating of the heart. The cells and tissues of the endocardium cover heart valves. The endocardium is of the same type of tissue that continuously grows to make the inner lining of blood vessels. That is why an infection of the endocardium can result in damage to the heart valves. The heart has 4 chambers: the right atrium, right ventricle, left atrium, and left ventricle. The heart valves separate each atrium from the ventricles and the ventricles from the pulmonary artery and aorta. These valves allow the blood to only go in one direction.
Endocarditis – Causes:
Endocarditis is inflammation of the endocardium, the inner lining of the heart. It is caused by bacteria, fungi, or other germs. If these germs invade the bloodstream, they can attach to abnormal areas of the heart. Usually the immune system will kill germs in the bloodstream. However, if a person’s heart has a rough lining or abnormal valves, the germs can attach and multiply in the heart. Because germs attach to abnormal areas, people with certain heart problems are at a higher risk of getting endocarditis. Examples of these heart problems include:
• An abnormal or damaged heart valve
• An artificial heart valve
• A severe case of mitral valve prolapse
Other factors can also play a role in causing endocarditis. Common activities, such as brushing your teeth or having certain dental procedures, can allow bacteria to enter your bloodstream. This is even more likely to happen if your teeth and gums are in poor condition. Bacteria can enter the bloodstream through a catheter or other medical device inserted through the skin, especially if these are kept in place for a long time. People who use IV drugs are also at risk of endocarditis because of germs on needles and syringes. Other infections in the body may sometimes spread to the bloodstream and cause endocarditis.
Symptoms
Endocarditis can cause a range of signs and symptoms. These signs and symptoms can vary greatly from person to person. They can also vary over time in the same person. Signs and symptoms of endocarditis differ depending on:
• The type of germ causing the infection
• Whether the infection develops quickly or slowly
• Whether the person has an underlying heart problem
Endocarditis commonly causes flu-like symptoms, including:
• Aching muscles and joints
• Chills
• Fever
• Headaches
• Night sweats
• Tiredness
The skin can also be affected by endocarditis. Common skin symptoms are:
• Paleness
• Small, painful, red or purplish bumps under the skin on the fingers or toes
• Small, dark, painless flat spots on the palms of the hands or soles of the feet
Endocarditis can also cause tiny spots on the skin from broken blood vessels. These spots may appear:
• Inside the cheeks
• On the chest
• On the roof of the mouth
• On the whites of the eyes
• Under the fingernails
Other common symptoms of endocarditis include:
• A new heart murmur or a change in an existing heart murmur
• Blood in the urine
• Change in appetite
• Nausea or vomiting
• Shortness of breath or cough that won’t go away
• Swelling in the feet, legs, or abdomen
• Weight loss
The symptoms of endocarditis may be caused by diseases other than endocarditis. If you have these symptoms, make sure to see a healthcare provider to find out what is causing your symptoms.
Complications:
As the germs that cause endocarditis multiply in the heart, they form clumps with other cells and matter found in the blood. These clumps are called vegetations. As endocarditis worsens, pieces of vegetations can break off and travel to other parts of the body. There, the pieces can block blood flow or cause a new infection. As a result, endocarditis can cause a range of complications. Heart problems are the most common complication of endocarditis. These problems may include:
• Heart failure
• Heart murmur
• Heart valve damage
• Problems with the heart’s electrical system
Rarely, endocarditis can also lead to a heart attack. The central nervous system can also be affected by endocarditis. The most common complication is when bits of the vegetation, called emboli, break away and lodge in the brain. The emboli can cause infections in the brain, strokes, or seizures. Endocarditis can also affect other organs in the body, such as the lungs, kidneys, and spleen. A vegetation or blood clot going to the lungs can cause a pulmonary embolism and lung damage. Other lung complications include pneumonia and a buildup of fluid or pus around the lungs. Kidney infections and kidney damage can also be caused by endocarditis. In some cases, endocarditis can cause kidney failure. In some people who have endocarditis, the spleen enlarges and can become damaged. The spleen is an organ located on the left side of the abdomen near the stomach. It filters the blood, stores blood cells, and destroys old blood cells.
Diagnosis:
Your healthcare provider will make a diagnosis based on your medical history, symptoms, and test results. There is no single test that can diagnose endocarditis. Your healthcare provider will first ask you about your medical history and symptoms. He or she will also perform a physical exam and run blood tests. Blood cultures are the most important blood test used to diagnose endocarditis. For this test, blood is drawn several times over a 24-hour period. The blood is put into special culture bottles that allow bacteria to grow. Doctors then identify the bacteria and see which antibiotics will kill them. Echocardiography, or echo, is a painless test that uses sound waves to create pictures of the heart. It can help doctors diagnose endocarditis. An EKG is a test that detects and records the heart’s electrical activity. It may be used to see if endocarditis is affecting the heart’s rhythm.
Treatment:
Endocarditis is treated with antibiotics. In some cases, surgery may also be needed. Antibiotics are usually given for 2 to 6 weeks through an intravenous, or IV, line inserted into a vein. The first week of treatment is often done in the hospital. If you are allowed to go home before treatment is done, the antibiotics may be continued at home. You will need special care for the IV treatment. Otherwise, antibiotics can be given during visits to your doctor’s office. Your doctor will monitor your condition carefully to prevent complications. Sometimes your doctor will refer you to a specialist in infectious diseases or a heart specialist for treatment. In some cases, surgery is needed to repair or replace a damaged heart valve or to help clear up the infection. Endocarditis caused by a fungal infection often requires surgery.
Summary:
Endocarditis is an inflammation of the endocardium, or the heart’s inner lining. It can damage the valves in the heart and lead to other complications. If left untreated, it can be life threatening. Endocarditis is caused by bacteria, fungi, or other germs. If these germs invade the bloodstream, they can attach to abnormal areas of the heart. Endocarditis is rare in healthy hearts. Endocarditis is treated with antibiotics given through an IV. In some cases, surgery may also be needed. Let your healthcare providers know if you have heart abnormalities that put you at risk for endocarditis. This includes your dentist. They can tell you whether you need antibiotics before exams and procedures to prevent endocarditis.
