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Endocarditis is a severe condition characterized by inflammation of the inner lining, known as the endocardium, of the heart’s chambers and valves. Factors that increase the likelihood of developing endocarditis include the presence of artificial heart valves, existing damage to the heart valves, or other congenital heart defects.
If left untreated, endocarditis can lead to severe complications, particularly in the form of damage or destruction of the heart valves. Such damage can impair the heart’s ability to pump blood effectively and lead to further cardiovascular complications.
The available treatment options for endocarditis consist of both medication-based approaches and surgical interventions.
Symptoms
The symptoms of endocarditis can vary from person to person and may develop gradually or suddenly, depending on the type of germs causing the infection and the presence of other heart problems. The following are commonly observed symptoms associated with endocarditis:
- Joint and muscle aches
- Chest pain during breathing
- Fatigue or excessive tiredness
- Sweating or chills, especially night sweats
- Shortness of breath
- Swelling in the feet, legs, or abdomen
- Detection of a new or altered whooshing sound in the heart (murmur)
Endocarditis may present with less commonly observed symptoms, such as:
- Unexplained weight loss
- Presence of blood in the urine
- Tenderness experienced under the left rib cage (spleen)
- Appearance of painless flat spots on the soles of the feet or palms of the hands, which may be red, purple, or brown in color (known as Janeway lesions)
- Development of painful bumps or darkened patches of skin on the fingertips or toes (referred to as Osler nodes)
- Presence of tiny round spots on the skin (petechiae) that are purple, red, or brown in color. These spots may also occur in the whites of the eyes or inside the mouth.
If you experience symptoms of endocarditis, it is crucial to seek immediate medical attention, particularly if you have a congenital heart defect or a history of endocarditis. Other less severe conditions can present similar signs and symptoms, making a thorough evaluation by a healthcare provider essential for an accurate diagnosis. If you have already been diagnosed with endocarditis and notice symptoms such as chills, fever, headaches, joint pain, or shortness of breath, it is important to inform your healthcare provider, as these symptoms may indicate a worsening of the infection.
Causes
Endocarditis is a condition that is often caused by an infection from bacteria, fungi, or other harmful microorganisms. These germs enter the bloodstream and make their way to the heart. In most cases, bacterial infections are responsible for endocarditis. The bacteria can enter the blood during dental procedures, such as tooth extractions, or through endoscopic examinations. Normally, the immune system in our bodies can eliminate any harmful bacteria that enter the bloodstream. However, if this defense mechanism fails, it can lead to endocarditis. The bacteria quickly form colonies, grow vegetation, and release enzymes that damage the surrounding tissue, creating a pathway for further invasion. While healthy heart valves are highly resistant to infection, bacteria can attach themselves to defects on the surface of diseased valves. Replacement heart valves are more susceptible to infection compared to normal valves.
Risk factors
Endocarditis can be caused by various factors, leading to the entry of germs into the bloodstream. While having a faulty or diseased heart valve increases the risk, it is important to note that endocarditis can occur in individuals without heart valve problems. Several factors can increase the likelihood of developing bacterial endocarditis:
- Advanced age: Endocarditis is more common in adults over the age of 60.
- Artificial heart valves: Germs are more likely to attach to prosthetic heart valves compared to natural heart valves.
- Acquired valve disease: Certain medical conditions, such as rheumatic fever or infection, can damage or scar the heart valves, increasing the risk of infection. Previous occurrences of endocarditis also raise the risk.
- Congenital heart defects: Individuals born with certain types of heart defects, including irregularities or damaged heart valves, have a higher risk of heart infections.
- Implantable devices: Bacteria can attach to implanted devices like pacemakers, leading to an infection of the heart’s lining.
- History of bacterial endocarditis: Individuals who have had endocarditis in the past are at an increased risk of developing it again.
- Suppressed immune system: People with weakened immune systems are more susceptible to infections, including endocarditis.
- Intravenous (IV) drug use: Using contaminated IV needles can lead to infections such as endocarditis. Individuals who use illegal IV drugs, like heroin or cocaine, face a particular risk due to the use of unsterilized equipment.
- Poor dental health: Maintaining good oral hygiene is crucial for overall health. Neglecting regular brushing and flossing can allow bacteria to grow in the mouth, potentially entering the bloodstream through cuts on the gums. Certain dental procedures that involve cutting the gums also pose a risk of introducing bacteria into the bloodstream.
- Long-term catheter use: Endocarditis risk is heightened when an indwelling catheter, which is a slender tube employed for various medical procedures, remains in place for an extended duration.
Diagnosis
To diagnose endocarditis, a healthcare provider will perform a physical examination and inquire about your medical history and symptoms. Various tests are conducted to confirm or rule out endocarditis. These tests include:
- Blood culture test: This test involves taking blood samples over a period of time to isolate the specific bacteria causing the infection. It is crucial to obtain blood cultures before starting antibiotics.
- Complete blood count (CBC): This test helps determine if there is an elevated number of white blood cells, which can indicate an infection. It can also help identify low levels of healthy red blood cells (anemia), which may be associated with endocarditis. Additional blood tests may be performed as well.
- C-reactive protein blood test: This blood test measures the levels of C-reactive protein, a substance that indicates inflammation in the body.
- Echocardiogram: Sound waves are used to create images of the heart, showing the pumping of blood, the structure of the heart, and the condition of its valves and chambers. Two types of echocardiograms are commonly used:
- Transthoracic echocardiogram (standard echocardiogram): A transducer device is moved over the chest area, emitting sound waves that are recorded as they bounce back from the heart.
- Transesophageal echocardiogram: A flexible tube containing a transducer is inserted through the throat into the esophagus. This procedure provides more detailed images of the heart compared to a standard echocardiogram.
- Electrocardiogram (ECG or EKG): This non-invasive test measures the heart’s electrical activity. It involves attaching electrodes to the chest and, in some cases, the arms or legs. Although not specifically used for diagnosing endocarditis, an electrocardiogram can detect any abnormalities in the heart’s electrical function.
- Chest X-ray: This imaging technique helps assess the condition of the lungs and heart. It can detect heart swelling caused by endocarditis or identify any signs of infection spreading to the lungs.
- Computerized tomography (CT) scan or magnetic resonance imaging (MRI): In certain cases, scans of the brain, chest, or other body parts may be necessary if there is suspicion of infection spreading to these areas.
- Positron emission tomography (PET) or nuclear medicine scans: These scans utilize radioactive material to create images that can indicate the location of an infection.
These tests collectively aid in the diagnosis of endocarditis by providing valuable information about the presence of bacteria or microorganisms, signs of inflammation, cardiac function, and potential spread of infection to other areas of the body.
Treatment
Endocarditis has the potential to significantly impact one’s quality of life. Upon diagnosis, prompt treatment becomes crucial to mitigate damage to the heart valves and prevent further complications. The primary course of action for many individuals with endocarditis involves the administration of antibiotics, leading to successful outcomes. In certain cases, surgical intervention may be necessary to repair or replace damaged heart valves and eliminate any remaining indications of the infection.
Medications
The treatment for endocarditis depends on the underlying cause of the infection. If the infection is bacterial, a broad-spectrum of intravenous (IV) antibiotics is typically used. Patients receiving IV antibiotics usually need to stay in the hospital for a week or longer to allow healthcare providers to assess the effectiveness of the treatment. Once the fever and severe symptoms subside, patients may be able to leave the hospital. However, some individuals may continue receiving IV antibiotics either through regular visits to a healthcare provider’s office or with home care. The course of antibiotics typically lasts for several weeks.
In cases where endocarditis is caused by a fungal infection, antifungal medication is administered. In some instances, individuals may require long-term use of antifungal pills to prevent the recurrence of endocarditis. After completing the treatment, healthcare providers will identify the sources of bacteria in the blood, such as dental infections, and address them accordingly. It is important to follow national guidelines and take prophylactic (preventive) antibiotics as prescribed to prevent future episodes of endocarditis.
Surgery
Heart valve surgery may be necessary for the treatment of persistent endocarditis infections or the replacement of a damaged valve. In cases where endocarditis is caused by a fungal infection, surgery may be required. Your healthcare provider will recommend either heart valve repair or replacement based on your specific condition. Heart valve replacement can involve the use of a mechanical valve or a biologic tissue valve made from cow, pig, or human heart tissue.
