Endocarditis

Description

Endocarditis is a life-threatening inflammation of the inner lining of the heart chambers and valves. This lining is called the endocardium.

Endocarditis is usually caused by an infection. Bacteria, fungi, or other microorganisms enter the bloodstream and attach to damaged areas in the heart. Things that make you more likely to get endocarditis are artificial heart valves, damaged heart valves or other heart defects.

Without rapid treatment, endocarditis can damage or destroy heart valves. Treatments for endocarditis include medications and surgery.

Symptoms

The symptoms of endocarditis may vary from person to person. Endocarditis may develop slowly or suddenly. Depends on the type of germ causing the infection, and if there are other heart problems.

The common symptoms of endocarditis are:

  • The pain of joints and muscles
  • Pain in the chest when you breathe
  • Fatigue
  • Flu-like symptoms, such as fever and chills
  • Night sweats
  • Shortness of breath
  • Swelling in the feet, legs, or abdomen.
  • A new or changed whooshing sound in the heart (heart murmur)

Least common endocarditis symptoms may include:

  • Unexplained weight loss
  • Blood in the urine
  • The tenderness under the rib cage left (spleen)
  • Painless, red, purple, or brown flat spots on the lower floor of the feet or the palms of the hands (lesions of Janeway)
  • Painful red or purple raised bumps or dark spots of the skin (the) on the tips of the fingers or toes (Osler nodes)
  • Tiny purple, red, or brown round spots on the skin (petechiae), in the white part of your eyes or the inside of the mouth

When to see a doctor

If you have symptoms of endocarditis, consult your health care provider as soon as possible — especially if you have a congenital defect of the heart or of the history of endocarditis. Less serious conditions can cause similar signs and symptoms. A proper assessment by a doctor is necessary to make the diagnosis.

If you have been diagnosed with endocarditis and have any of the following symptoms, call your care provider. These symptoms may mean that the infection is getting worse:

  • Chills
  • Fever
  • Headaches
  • Pain in the joints
  • Shortness of breath

Causes

Endocarditis is usually caused by an infection with bacteria, fungi, or other microorganisms. The germs enter the bloodstream and travel to the heart. In the heart, adhere to the damage to the heart valves or damaged heart tissue.

Normally, the body's immune system destroys the harmful bacteria that enter the bloodstream. However, the bacteria on the skin or in the mouth, throat or bowel (intestine) can enter the bloodstream and cause endocarditis, under the right circumstances.

Risk factors

Many different things can cause germs to enter the bloodstream and cause endocarditis. Having a defective, damaged or diseased heart valve, increases the risk of the disease. However, the endocarditis may occur in those without heart valve problems.

Risk factors for endocarditis include:

  • Advanced age. Endocarditis occurs most often in adults over 60 years of age.
  • Artificial heart valves. The germs are more likely to adhere to an artificial (prosthetic) heart valve regulating valve of the heart.
  • Damaged heart valves. Certain medical conditions, such as rheumatic fever or infection, can damage or scar of one or more of the valves of the heart, increasing the risk of infection. A history of endocarditis also increases the risk of infection.
  • Congenital heart defects. Being born with certain types of congenital heart defects, such as an irregular beating of the heart or of the heart valves are damaged, increasing the risk of heart infections.
  • Implanted heart device. The bacteria can attach to an implanted device, such as a pacemaker, causing an infection of the heart lining.
  • Illegal intravenous (IV) drug use. Using foul IV needles can lead to infections such as endocarditis. Contaminated needles and syringes are a special concern for people who use illegal intravenous drugs, such as heroin or cocaine.
  • Poor dental health. A healthy mouth and healthy gums are essential to good health. If you don't brush and floss regularly, bacteria can grow on the inside of your mouth, and can enter the bloodstream through a cut in your gums. Some dental procedures that can cut the gums can also allow the entry of bacteria into the bloodstream.
  • Long-term catheter use. A catheter is a thin tube that is used to do some medical procedures. Have a catheter in place for a long period of time (indwelling catheter) increases the risk of endocarditis.

If you are at risk of endocarditis, tell your health care provider. You can request a endocarditis wallet card from the American Heart Association. Check with your local chapter or print the card from the website of the association.

Complications

In endocarditis, irregular growths made of germs and cells parts form a mass in the heart. These groups are called vegetations. They can break off and travel to the brain, lungs, kidneys, and other organs. You can also travel to the arms and legs.

The complications of endocarditis may include:

  • Heart failure
  • A damaged heart valve
  • Stroke
  • Pockets of collection of pus (abscesses) that develop in the heart, brain, lungs and other organs
  • Blood clot in a lung artery (pulmonary embolism)
  • Kidney damage
  • Enlargement of the spleen

Prevention

You can take the following steps to help prevent endocarditis:

  • Know the signs and symptoms of endocarditis. Consult your health-care provider immediately if you experience any of the symptoms of the infection, especially, a fever that does not go away, unexplained fatigue, any type of infection of the skin or on open wounds or sores that do not heal properly.
  • Take care of your teeth and gums. Brush and floss your teeth and gums with frequency. Get regular dental check-ups. Good dental hygiene is an important part of maintaining your health in general.
  • Do not use illegalIVdrugs. Dirty needles can send bacteria into the bloodstream, which increases the risk of endocarditis.

The use of preventive antibiotics

Certain dental and medical procedures can allow bacteria to enter the bloodstream.

If you are at high risk of endocarditis, American Heart Association's recommended to take antibiotics an hour before having any dental work done.

You are at high risk of endocarditis, and you need antibiotics prior to dental work if you have:

  • A history of endocarditis
  • A mechanical heart valve
  • A heart transplant, in some cases
  • Certain types of congenital heart disease
  • Congenital heart disease surgery in the last six months

If you have endocarditis, or any type of congenital heart disease, talk with your dentist and other health care providers about their risk, and whether you need preventive antibiotics.

Endocarditis

Diagnosis

To diagnose endocarditis, a physician performs a physical examination and will ask you questions about your medical history and symptoms. Tests are done to help confirm or rule out endocarditis.

Tests

The tests are used to diagnose endocarditis include:

  • The blood culture test. This test helps to identify the germs in the bloodstream. The results of this test helps to determine the antibiotic or combination of antibiotics used for treatment.
  • Complete blood count. This test can determine if there is a large amount of white blood cells, which may be a sign of infection. A complete blood count can also help to diagnose the low levels of red blood cells (anemia), which can be a sign of endocarditis. Other blood tests may also be done.
  • The echocardiogram.Use sound waves to create images of the beating heart. This test indicates the shape of the heart chambers and valves of the blood pump. You can also display the heart of the structure. Your healthcare provider may use two different types of echocardiograms to help the diagnosis of endocarditis. In a standard (transthoracic) echocardiogram, wandlike device (transducer) is moved over the area of the chest. The device directs sound waves into the heart and records them as they are retrieved. In a transesophageal echocardiogram, a flexible tube that contains a transducer is guided through the throat and into the tube that connects your mouth and stomach (esophagus). A transesophageal echocardiogram provides a greater amount of detailed pictures of the heart that is possible with an echocardiogram standard.
  • Electrocardiogram (ECG or EKG). This quick and painless test that measures the electrical activity of the heart. During an ECG, sensors (electrodes) are attached to the chest and, at times, the arms or the legs. It is not specifically used to diagnose endocarditis, but it can show if something is affecting the electrical activity of the heart.
  • X-ray of the chest. An x-ray of the chest shows the condition of the lungs and the heart. This can help determine if the endocarditis has caused swelling of the heart or if the infection has spread to the lungs.
  • The computed tomography (CT) or magnetic resonance imaging (MRI). You may need scans of his brain, chest, or other parts of your body if your doctor believes that the infection has spread to these areas.

The echocardiogram. Use sound waves to create images of the beating heart. This test indicates the shape of the heart chambers and valves of the blood pump. You can also display the heart of the structure. Your healthcare provider may use two different types of echocardiograms to help the diagnosis of endocarditis.

In a standard (transthoracic) echocardiogram, wandlike device (transducer) is moved over the area of the chest. The device directs sound waves into the heart and records them as they are retrieved.

In a transesophageal echocardiogram, a flexible tube that contains a transducer is guided through the throat and into the tube that connects your mouth and stomach (esophagus). A transesophageal echocardiogram provides a greater amount of detailed pictures of the heart that is possible with an echocardiogram standard.

Treatment

Many people with endocarditis are successfully treated with antibiotics. Sometimes, surgery may be needed to repair or replace damaged heart valves, and clean up any remaining signs of the infection.

Drugs

The type of medicine you receive depends on what is the cause of the endocarditis.

High doses of antibiotics are used to treat endocarditis caused by bacteria. If you get antibiotics, usually, spend a week or more in the hospital, so that healthcare providers can determine if the treatment is working.

Once the fever, and severe allergies symptoms have disappeared, you may be able to leave the hospital. Some people continue the antibiotics with the visit to a doctor's office or at home with home care. Antibiotics are usually taken for several weeks.

If endocarditis is caused by a fungal infection, antifungal medications are given. Some people need all of the life antifungal pills to prevent endocarditis of return.

Surgery or other procedures

Heart valve surgery may be needed to treat persistent endocarditis infections or to replace a damaged valve. Surgery is sometimes necessary for the treatment of endocarditis which is caused by a fungal infection.

Depending on your specific condition, your health care provider may recommend heart valve repair or replacement. Heart valve replacement using a mechanical valve or a valve from a cow, pig or human heart tissue (biological tissue valve).

Preparing for your appointment

The first health care provider, you ve probably, your primary care physician or a physician in the emergency department. You may be referred to a physician or surgeon who is trained in the diagnosis and treatment of diseases of the heart (cardiologist).

What you can do

You can help to prepare for your appointment, follow these steps:

  • Write down any symptoms you are having. Be sure to take note of how long you've had. If you have had similar symptoms that have occurred in the past, be sure to include that information.
  • Make a list of important medical information. Make a note of any other recent health issues he has had. List of the names of all the medications and supplements you are taking. Include their dosages.
  • Ask a family member or friend to go with you to the appointment. Someone who goes with you can help you remember what your doctor says.

It is also important to write down any questions that you may have prior to arriving to your appointment. For endocarditis, some basic questions that you might want to ask your health care provider include:

  • What is the most likely cause of my symptoms?
  • What kinds of tests do I need? How do I prepare for the tests?
  • What treatment do you recommend it?
  • How soon after the start of the treatment I'm going to start to feel better?
  • What are the possible side effects?
  • Am I at risk of long-term complications of this condition? It's going to come back?
  • How often should I follow for this condition?
  • Do I need to take preventive antibiotics for certain medical or dental procedures?
  • I have other medical conditions. How can I best manage these conditions?

What to expect from your doctor

Your doctor will probably ask a lot of questions, including:

  • What are your symptoms?
  • When did the symptoms begin? Arrived suddenly or gradually?
  • Has had similar symptoms in the past?
  • Are you having difficulty breathing?
  • You have recently had an infection?
  • Have you recently had a fever?
  • Has had recently, medical or dental procedures that use needles or catheters?
  • Have you ever used drugs?
  • You've lost weight recently without trying?
  • Have you been diagnosed with any other medical conditions, especially heart murmurs?
  • Do any of your first-degree relatives such as parents, siblings or children — has a history of heart disease?
Symptoms and treatment of Endocarditis