Endocarditis is a rare health condition that involves inflammation of the heart lining, heart muscles, and heart valves.
It is also called infective endocarditis (IE), bacterial endocarditis (BE), infectious endocarditis, and fungal endocarditis.
An infection of the endocardium creates endocarditis. The infection is usually caused by streptococcal or staphylococcal bacteria. Rarely, it can be caused by fungi or other infectious micro-organisms.
It occurs twice as common in men as in women. In the United States, over 25percent of cases affect people aged 60 years or above.
Studies shows that endocarditis affects at least 4 in every 100,00 people each year and the number is rising.
Causes and risk factors
Endocarditis is basically inflammation that affects the heart.
Endocarditis can occur when bacteria or fungi enter the body because of an infection, or when normally harmless bacteria that live in the mouth, upper respiratory tract, or other components of the body attack the heart tissue.
Normally, the immune system can kill these unwanted micro-organisms, but any damage to the heart valves can allow them to attach themselves to the heart and to increase.
Clumps of bacteria and cells, or vegetation, form on the heart valves. These clumps make it harder for the heart to work normally.
They can create abscesses on the valves and the heart muscle, damage tissue, and lead to abnormalities in electrical body conduction.
Sometimes, a clump can break off and spread to other areas, such as the kidneys, lungs, and brain.
A dental problem or procedure that leads to in an infection can trigger it. Poor health in the teeth or gums increases the risk of endocarditis, as this makes it easier for the bacteria to get in. Good dental hygiene helps keep heart infection.
Other surgical procedures can let bacteria to enter, including tests to examine the digestive tract, for example, a colonoscopy. Procedures that affect the breathing tract, the urinary tract, including kidneys, bladder, and urethra, the skin, the bones and the muscles, are also risk factors.
A heart defect can add the risk of developing endocarditis if bacteria enter the body. This can include a defect from birth, an abnormal heart valve or damaged heart tissue. People with an artificial heart valve have a higher risk.
A bacterial infection in another part of the body, for example, a skin sore or a gum disease, can result to the spread of bacteria. Injecting drugs with unclean needles is a risk factor. Anyone who develops sepsis is at risk of endocarditis.
Sexually transmitted infections (STIs), like chlamydia or gonorrhea make it easier for bacteria to enter the body and make their way to the heart.
A candida fungal infection can create endocarditis.
Inflammatory bowel disease (IBD) or any intestinal disorders can also increase the risk, but the risk of a person with IBD developing endocarditis is still low.
Surgical or medical tools used in treatment, such as a urinary catheter or long-term intravenous medication can increase the risk.
A person may stand a higher risk of developing endocarditis if they:
- have an existing heart condition or disease
- have had heart replacement surgery or gotten an artificial heart valve
- have had a disease, such as rheumatic fever, which damaged at a heart valve
- have received a pacemaker
- have regularly received drugs intravenously
- are convalescing after a serious bacterial illness, such as meningitis or pneumonia
- have an immune system that is chronically suppressed, for example, as a result of diabetes or HIV, or if they have cancer or are getting chemotherapy.
As people age, their heart valves degenerate, adding the risk of endocarditis.
Signs and symptoms
Symptoms differ between individuals, and individual symptoms can change over time.
In sub-acute endocarditis, symptoms showup slowly over several weeks, and possibly several months.
Rarely, the infection starts rapidly, and symptoms appear abruptly. This is called acute endocarditis, and symptoms tend to be more severe.
Endocarditis is hard to diagnose. Symptoms may vary in severity, depending on the type of bacteria or fungi causing the infection. Patients with underlying heart issues tend to have more severe symptoms.
Symptoms could include:
Symptoms could be inclusive of fever, chest pain, and fatigue.
- A high temperature, or fever
- A new or different heart murmur
- Muscle pain
- Bleeding under the fingernails or toenails
- Broken blood vessels found in the eyes or skin
- Chest pain
- Shortness of breath, or panting
- Small painful, red or purple lumps, or nodules, on the fingers, toes, or both
- Small, painless, flat spots on the sole of the feet or palms of the hands
- Small spots from broken blood vessels under the nails, on the whites of the eyes, on the chest, in the roof of the mouth and inside the cheeks
- Sweating, including night sweats
- Swelling of the limbs or abdomen
- Blood in the urine
- Weakness, tiredness, and fatigue
- Unexpected weight loss
These signs may not be specific to endocarditis.
Diagnosis and treatment
The doctor will ask about the patient’s medical history and identify any possible heart issues and recent medical procedures or tests, such as operations, biopsies or endoscopies.
They will also confirm for fever, nodules, and other signs and symptoms, such as a heart murmur, or an altered heart murmur if the patient already had one.
A series of tests can be used to confirm endocarditis. The symptoms of endocarditis may overlap with those of other situations, so these may need to be ruled out first. This may require some time.
The following tests may be done:
- Blood culture test: to inspect for bacteria or fungi in the patient’s blood. If any are found, they are usually tested with some antibioticsto find out which treatment is best.
- Erythrocyte sedimentation rate (ESR): this test looks at how fast the patient’s blood falls to the bottom of a test tube full of liquid. The faster the cells fall, the more likely it is that there is an inflammatory condition, such as endocarditis. Most patients with endocarditis have high ESR. The blood reaches the bottom of the liquid faster than normal.
- Echocardiogram: sound waves generate images of the parts of the heart, including muscle, valves, and chambers. This shows the structure and workings of the heart in more detail. An echocardiogram can show clumps of bacteria and cells, known as vegetations, and infected or damaged heart tissue.
A CT scan can assist to pinpoint any abscesses in the heart.
The main course of treatment is antibiotics, but often times surgery is necessary.
Most patients with endocarditis will get antibiotics. These will be given intravenously, through a drip, so the patient will need to stay in the hospital. Regular blood tests will monitor the effectiveness of the medication.
Patients can usually go home when their temperature returns to normal and symptoms have subsided, but most will continue to take antibiotics at home.
The patient should stay in touch with their doctor to make sure the treatment is effective, and that side effects are not stopping recovery.
The most regularly used antibiotics are penicillin and gentamycin. Patients who are allergic to penicillin may be given vancomycin. Antibiotic treatment normally lasts from 2 to 6 weeks, depending on the severity of the infection, among other things.
If the endocarditis has damaged the heart, surgery may be required.
Heart surgery may be required if there is damage to the heart valves.
Surgery is recommended if:
- the heart valve is so damaged that it doesnt close tightly enough, and regurgitation happen, where the blood flows back into the heart
- the infection continues because the patient does not respond to antibiotic or antifungal medication
- large clumps of bacteria and cells, or vegetations, are attached to a heart valve
Surgery may repair a heart bad or damaged heart valves, change them with artificial ones, or drain the abscesses that have developed within the heart muscle.
Complications, outlook, and prevention
Complications are more likely if endocarditis is allowed untreated, or if treatment is delayed.
- Damaged heart valves heightens the risk of heart failure.
- If heart rhythms are affected,arrhythmia , or irregular heartbeat, may happen.
- The infection can spread within the heart and to other organs, such as the kidneys, lungs, and brain.
- If vegetations break off, they can travel through the bloodstream to other parts of the body and create infections and abscesses elsewhere.
Vegetation that finds its way to the brain and gets stuck there can cause stroke or blindness. A large vegetation can get stuck in an artery and block blood flow.
Outlook and prevention
Untreated endocarditis is always fatal, but with early treatment, involving an aggressive use of antibiotics, most patients survive.
However, it can still get fatal in older people, patients with an underlying condition, and those whose infection involves a resistant type of bacteria.
The National Heart, Lung and Blood Institute (NHLBI) encourage those who are at risk of endocarditis to have regular dental checkups and to brush and floss their teeth regularly.
Since 2007, the American Heart Association has recommended that those with a high risk of endocarditis should get antibiotics before undergoing dental procedures.