Endocarditis

2021-07-31 10:59 AM

May develop slowly or suddenly, may cause fever, chills, new or changed heart murmur, fatigue, joint pain.

Define

Endocarditis is an infection of the inner lining of the heart (endocardium).

Endocarditis usually occurs when bacteria or other germs from another part of the body, such as the mouth, spread through the bloodstream and attach to damaged areas in the heart. If left untreated, endocarditis can damage or destroy heart valves and can lead to life-threatening complications. Treatment for endocarditis includes antibiotics and, in severe cases, surgery.

Endocarditis is uncommon in people with healthy hearts. People are at greatest risk of endocarditis when they have damaged heart valves, artificial heart valves, or other heart valve defects.

Symptoms

Endocarditis can develop slowly or suddenly, depending on the cause of the infection and any underlying heart problems.

Endocarditis, signs, and symptoms may include:

Fever.

Chills.

New or changed heart murmur, the abnormal sound of blood through the heart.

Tired.

Pain in joints and muscles.

Night sweats.

Shortness of breath.

Skin pale.

Persistent cough.

Swollen legs or abdomen.

Unexplained weight loss.

Blood in the urine.

Pain in the spleen.

Osler's red nodes, the points under the skin of the fingers.

Tiny purple or red petechiae on the skin, whites of the eyes, or inside the mouth.

If you develop signs or symptoms of endocarditis, see your doctor right away, especially if you have serious risk factors for this infection, such as a heart defect or a previous case of endocarditis. this.

Although few serious problems can cause similar signs and symptoms, you won't know for sure until you see your doctor.

Causes

Endocarditis occurs when bacteria enter the bloodstream to the heart and attach to abnormal heart valves or damaged heart tissue. Bacteria are responsible for most cases, but fungi or other microorganisms may also be responsible.

Sometimes the culprit is one of many types of bacteria that normally live in the mouth, throat, or another part of the body. In other cases, the culprit organism can enter the bloodstream through:

Daily activities. Activities such as brushing or chewing food can allow bacteria to enter the bloodstream, especially if the teeth and gums are deeply inflamed.

Infections or other medical conditions. Bacteria can spread from an infected area such as dermatitis, gum disease, sexually transmitted disease or intestinal disorders - such as inflammatory bowel disease can also provide an opportunity for bacteria to enter the bloodstream.

Catheter or needle. The bacteria can enter the body through a catheter - a small tube that doctors sometimes use to inject or remove fluid from the body. Bacteria that can cause endocarditis can also enter the bloodstream through needles used for tattoos or body piercings. Contaminated needles are a concern for people using intravenous (IV) medications.

Certain dental procedures. Some gum dental procedures can allow bacteria to enter the bloodstream.

Normally, the immune system destroys bacteria into the bloodstream. Even if bacteria reach the heart, they can pass through without causing an infection.

Most people who develop endocarditis have diseased or damaged heart valves, an ideal place for bacteria. Damaged tissue in the endocardium with a rough surface allows bacteria to reside and multiply.

Risk factors

If the heart is healthy, it is unlikely to develop endocarditis. Even this type of heart disease does not increase the risk of endocarditis. The germs that cause the infection tend to stick to and multiply in damaged or surgically implanted heart valves.

The highest risks of endocarditis:

Artificial heart valve. Pathogens are more likely to attach to an artificial (false) heart valve than to a normal heart valve. The risk of infection is highest in the first year after transplant.

Congenital heart defects. If you are born with some type of heart defect, your heart may be more susceptible to infection.

Previous history of endocarditis. Endocarditis is often damaged by the tissues and valves of the heart, increasing the risk of future heart infections.

Damaged heart valve. Some medical conditions, such as rheumatic fever or infections, can damage or scar one or more heart valves, making them more susceptible to endocarditis.

History of illegal drug use. People who use illegal drugs by injecting them have a greater risk of endocarditis. Needles used to inject drugs are often contaminated with bacteria that can cause endocarditis.

If you have a known heart defect or heart valve problem, ask your doctor about your risk of developing endocarditis. Even if heart disease is repaired or causes no symptoms, there is still a risk.

Complications

Endocarditis can cause many major complications:

Stroke and organ damage. In endocarditis, clusters of bacteria and cellular debris form in the heart. The mass can rupture and travel to the brain, lungs, abdominal organs, kidneys, or extremities. This can cause various problems, including stroke or damage to other organs or tissues.

Infections in other parts of the body. Endocarditis can cause abscesses to develop in other parts of the body, including the brain, spleen, kidneys, or liver. Abscesses can develop in the heart muscle causing an irregular heartbeat. Severe abscesses may require surgery to treat.

Heart failure. If left untreated, endocarditis can damage heart valves and permanently destroy the heart's inner lining (endocardium). This can make the heart work harder to pump blood, eventually causing heart failure, a chronic condition in which the heart cannot pump enough blood to meet the body's needs. If the disease progresses untreated, it is often fatal.

Testing and diagnosis

Your doctor may suspect endocarditis based on your medical history and physical signs and symptoms, such as fever. Using a stethoscope to listen to your heart, your doctor may hear a new heart murmur or a change in a previous murmur, which may show signs of endocarditis.

The infection can mimic other diseases in the early stages. Various tests may be needed to help make the diagnosis:

Blood tests. The most important test is blood which is used to identify bacteria in the blood. Blood tests can also help your doctor identify certain conditions, including anemia - a lack of healthy red blood cells that can be a sign of endocarditis.

Transesophageal echocardiography. An echocardiogram uses sound waves to create images of the heart. This type of echocardiogram allows the doctor to get a closer look at the heart valves. It is often used to check for warts or infected tissue. In this test, an ultrasound device is passed through the mouth into the esophagus - the tube that connects the mouth and stomach.

Electrocardiogram (ECG). Your doctor may test this noninvasively if you think endocarditis may be causing an irregular heartbeat. In an electrocardiogram, a sensor (electrode) that can detect the electrical activity of the heart is attached to the chest and sometimes to the limbs.

X-ray. X-ray images help the doctor see the condition of the lungs and heart. Your doctor can use X-ray images to see if endocarditis has caused the heart to enlarge or if the infection has spread to the lungs.

Computed tomography (CT scan) or magnetic resonance imaging (MRI). A CT or MRI of the brain, chest or other parts of the body may be needed if the doctor thinks the disease has spread to these areas.

Treatments and drugs

The first line of treatment for endocarditis is antibiotics. Sometimes, if a heart valve is damaged by an infection, surgery is needed.

Antibiotics

If endocarditis is present, high doses of intravenous (IV) antibiotics may be needed in the hospital. Blood tests can help identify microorganisms that infect the heart. This information will help your doctor choose the best antibiotic or antibiotic combination to fight infection.

It will usually take 4-6 weeks or more of antibiotics to clear up the infection. Once the fever is gone and the worst of the signs and symptoms has passed, it is possible to leave the hospital and continue intravenous antibiotic therapy with follow-up visits, which will need to be seen regularly by the doctor to make sure ensure effective treatment.

Report to your doctor any signs or symptoms of an infection that are getting worse, such as:

Fever.

Chills.

Headache.

Arthritis.

Shortness of breath.

Diarrhea, rash, itching, or joint pain may indicate a reaction to antibiotics, which is also a reason to call your doctor.

See a doctor right away if you experience shortness of breath or swelling in your legs, ankles, or feet. These signs and symptoms may indicate heart failure.

Surgery

If this damage infects the heart valves, there may be symptoms and complications for many years after treatment. Sometimes surgery is needed to treat a persistent infection or to replace a damaged valve. Surgery is also sometimes needed to treat endocarditis caused by a fungal infection.

Depending on the condition, your doctor may recommend either repairing the damaged valve or replacing it with an artificial valve made of animal tissue or other artificial materials.

Lifestyle and remedies

If you are at risk for endocarditis, let all health care providers know.

To help prevent endocarditis, make sure to practice good hygiene:

Pay special attention to oral health. Brush and floss your teeth and gums regularly, and get regular dental checkups.

Avoid procedures that can lead to skin infections. Such as piercings or tattoos.

Seek medical attention right away if you develop any type of skin infection or open cuts or sores that do not heal properly.

Prevention

People with the following heart problems are at increased risk of serious endocarditis:

Artificial (prosthetic) heart valve.

History of infective endocarditis.

Certain types of congenital heart defects.

Complicated transplant of heart problem.

People with these problems may need to take prophylactic antibiotics before certain medical or dental procedures to prevent endocarditis.

Prophylactic antibiotics

Certain dental and medical procedures can allow bacteria to enter the bloodstream. Antibiotics are taken before the procedure can help kill or control the harmful bacteria that can lead to endocarditis.

Antibiotics are recommended only before the following procedures:

Certain dental procedures. People who cut gum tissue or part of a tooth.

The procedure involves the respiratory tract, infected skin, or the tissue that connects muscle to bone.

Antibiotics are no longer recommended before all dental procedures or procedures of the urinary tract or digestive system.

If you have had to take prophylactic antibiotics in the past before a dental procedure, you may be concerned about these changes. In the past, there were antibiotics because of a concern that routine dental procedures increased the risk of endocarditis. But as doctors have been doing more research on endocarditis prevention, they've realized that endocarditis can happen more from accidental exposure to germs than from a dental exam. or orthopedic surgery.

This is not to say that it is not important to take good care of your teeth, brushing, and flossing. There is some concern that infections in the mouth from poor oral hygiene may increase the risk of germs entering the bloodstream. In addition to brushing and flossing, regular dental checkups, at least annually, are an important part of maintaining good oral health.