Infective endocarditis

Last reviewed: April 26, 2024

Endocarditis is a serious condition that causes inflammation of the inner lining of the heart, including its chambers and valves. It can be fatal if not treated promptly. The condition is usually caused by an infection, for example, bacteria or fungi from other parts of the body such as the mouth, which enter the bloodstream and stick to damaged areas in the heart. Endocarditis can cause severe damage to or destruction of the heart valves, which is why it requires immediate medical attention. Treatment options include medications and surgery, with individuals who have artificial or damaged heart valves or other cardiac conditions being at higher risk. If left untreated, endocarditis can lead to serious complications such as heart failure, stroke, damage to other organs, and even death. Generally, healthy individuals do not develop this condition, while those with existing cardiac issues are at greater risk.

Symptoms

If left untreated, infective endocarditis can have fatal consequences. Unfortunately, its signs and symptoms often overlap with those of various other health conditions.

The progression of endocarditis can vary, occurring suddenly or gradually depending on the type of pathogens causing the infection and the patient’s heart health history. While signs and symptoms can differ from person to person, common indicators of endocarditis may include:

  • Chest pain in breathing
  • Fatigue
  • Night sweats
  • Aching joints and muscles
  • Flu-like symptoms, such as fever and chills
  • Swelling in the feet, legs, or abdomen
  • Shortness of breath
  • A changed or new heart murmur is the heart sound caused by blood rushing through the heart

Less common signs and symptoms of endocarditis can include:

  • Blood in the urine, which is tested in a urine sample
  • Unexplained loss in weight
  • Sensitivity or pain in the spleen, an organ responsible for fighting infections, situated beneath the left rib cage.
  • Osler’s nodes - Red, tender spots under the skin of toes or fingers
  • Janeway lesions - Red spots on the soles of feet or the palms of hands
  • Tiny red or purple spots, named petechiae (puh-TEE-kee-ee), on the skin, in the whites of the eye, or inside the mouth.

Causes

Usually, the immune system can eliminate harmful bacteria that enter the bloodstream. However, bacteria residing in the throat, mouth, or other body parts, like the gut or skin, can sometimes lead to endocarditis. Various routes exist through which fungi, bacteria, and other germs causing endocarditis can enter the bloodstream:

  1. Poor dental care: Inadequate brushing and flossing can result in gum disease. When gums are unhealthy and bleed during brushing, bacteria can seize the opportunity to enter the bloodstream. Specific dental procedures that may cause gum cuts can also facilitate bacterial entry into the bloodstream.
  2. Catheters: Bacteria can enter the body through thin tubes known as catheters, which doctors use to inject or withdraw fluids from the body. This often occurs with prolonged catheter use, such as in long-term dialysis.
  3. Illegal intravenous drug use: Those who use illegal intravenous drugs like cocaine or heroin face the risk of bacterial contamination through the use of unclean syringes and needles. Frequently, individuals engaging in this behavior lack access to clean and unused needles or syringes.

Risk factors

Individuals with diseased, faulty, or damaged cardiac valves are at a heightened risk of developing endocarditis. Generally, endocarditis is uncommon in those who are in good health. Factors that increase the risk of endocarditis include:

  • Artificial cardiac valves: Germs and bacteria are more prone to attach to artificial (prosthetic) cardiac valves than normal ones.
  • Older age: Endocarditis is more prevalent among older adults aged 60 years and above.
  • Damaged cardiac valves: Certain medical conditions, such as rheumatic fever or infection, can damage or scar one or more cardiac valves, increasing the risk of infection.
  • Congenital cardiac defects: Individuals born with certain cardiac defects, such as irregular or abnormal heart valves, are more susceptible to infection.
  • Implanted heart device: Bacteria can adhere to an implanted device, such as a pacemaker, leading to an infection of the heart’s lining.
  • History of endocarditis: Previous episodes of endocarditis can cause damage to cardiac tissues and valves, elevating the risk of future heart infections.
  • Poor dental health: Neglecting regular brushing and flossing can lead to the growth of germs in the mouth, increasing the risk of bloodstream entry through gum cuts.
  • History of illegal intravenous drug use: Individuals who inject illegal drugs are at a higher risk of endocarditis. Contaminated syringes and needles used for drug injection can harbor germs that cause endocarditis.
  • Long-term catheter use: Prolonged use of catheters, particularly indwelling catheters, can heighten the risk of endocarditis.

Complications

In cases of endocarditis, bacterial and cellular debris clump together to form abnormal masses within the heart, known as vegetations. These vegetations can potentially detach and travel to various parts of the body, including the lungs, brain, kidneys, abdominal organs, or extremities. Consequently, endocarditis can result in several complications, including:

  • Kidney damage
  • Enlarged spleen
  • Cardiac issues such as heart murmurs, heart valve damage, and heart failure
  • Formation of pus-filled pockets (abscesses) in the heart, lungs, brain, and other organs
  • Stroke
  • Pulmonary embolism - a blood clot in a lung artery

Treatment

Antibiotics are the primary treatment for endocarditis caused by bacteria. Intravenous antibiotic therapy is typically administered to effectively treat the infection and associated inflammation. This treatment is usually conducted in a hospital setting for at least seven days until signs of improvement are observed. Regular antibiotic therapy will be required upon discharge, often continuing for up to six weeks. Transition to oral antibiotics may be possible later in the treatment process.

Surgery

Chronic infective endocarditis or damaged cardiac valves caused by endocarditis can necessitate surgery to cure. Surgery can be done to remove any dead tissue, fluid buildup, scar tissue, or debris from infected tissue. Surgery can also be done to remove or repair your damaged cardiac valve and replace it with animal tissue or artificial material.

Work cited

This page was last reviewed and updated by on Apr 26, 2024.

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