Definition & Overview

The heart is well protected against harmful bacteria. Most of the time, bacteria simply pass through the heart without causing any harm. However, if the heart (specifically the valves) has problems or is damaged, bacteria stick to the inner linings and cause an infection. This condition called is endocarditis.

Endocarditis is a rare condition, but it can cause life-threatening complications when left untreated. The most common complications are heart failure and stroke.

While the disease can affect anybody, it is more common in older people who previously had heart valve problems, such as those who have undergone heart valve replacement surgery, or are using a pacemaker or implantable cardioverter-defibrillator (ICD). However, having heart problems do not necessarily increase the risk of endocarditis. For instance, coronary artery stents, heart bypass surgery, and heart attack are just some of the common heart problems that are not associated with the condition.

Cause of Condition

Endocarditis occurs when germs enter the bloodstream. Since every drop of blood in the human body passes through the heart, the germs pass through the heart as well. Normally, the heart has a sufficient amount of protection against bacteria, which is why it is seldom affected. However, in some cases, this protection is weakened and germs stick to the heart’s inner lining. When this happens, the germs cause an infection, which will lead to endocarditis.

Bacterial infections and fungi called Candida are the most common causes of endocarditis. However, in some cases, doctors are unable to determine the exact cause of the condition.

Germs can enter the blood stream through several different ways, such as unsterile needles used in intravenous lines (IV lines), or when someone uses illegal drugs through injections. It can also happen during dental surgery or other types of surgeries on the respiratory tract, urinary tract, bones, muscles, or skin.

It’s imperative that an infected person receives treatment for endocarditis as soon as possible. Unfortunately, due to the nature of the symptoms, some people are not diagnosed with the disease until it has progressed.

Key Symptoms

One of the reasons why patients do not immediately seek treatment for the condition is because of its flu-like symptoms, such as chills, fever, fatigue, joint pains, and night sweats. The patient will normally experience weight loss, shortness of breath, and cough. In some cases, tiny red or purple spots are noticeable under the skin, or blood appears under the fingernails.

However, unlike flu, those symptoms do not go away easily. Some people may notice the symptoms going away for a bit, only to come back after a while.

If you notice these symptoms, don’t assume that you have the flu, especially if you have one or more of the risk factors. It’s best that you consult a medical professional to reduce the risks of the disease developing complications that are far more serious.

Who to See & Types of Treatment Available

If you’re experiencing the symptoms, make sure that you consult your family doctor, who will examine your family history of diseases before performing a thorough physical examination, which includes listening to heart using a stethoscope, especially if you have history of a heart murmur.

Your doctor will be listening for new heart murmur or changes in a previous heart murmur. Since endocarditis symptoms are often similar to other ailments, your doctor may perform several other tests to determine the exact cause of your condition. These tests include blood tests, electrocardiogram, transesophageal echocardiogram, chest x-ray, a CT scan or an MRI.

Blood tests are performed to determine the presence of bacteria in the blood. A transesophageal echcocardiogram will help the doctor analyze the condition of the heart, and look for infections as well. An electrocardiogram (ECG) will determine if you have irregular heartbeats, which is common in patients with endocarditis. Imaging tests, such as a chest x-ray, MRI, or CT scan will show the doctor any changes in the heart.

If the doctor confirms endocarditis, you’ll undergo treatment immediately. The first line of treatment will be medications to control the infection. Medications will include high doses of antibiotics that are administered using an IV line. You’ll need to be fed the antibiotics intravenously until the symptoms of the infection have reduced. If the doctor determines that you’re in a stable condition, you’ll be allowed to return home, but you’ll likely need to continue antibiotic treatment.

Your doctor will instruct you on when you’ll need to report to the clinic for a checkup. However, this does not mean that you’ll need to wait for the exact date to see the doctor. If you experience fever, chills, joint pains, shortness of breath, and headaches, you will need to inform the doctor immediately so that your treatment can be adjusted accordingly.

The reason why endocarditis needs to be treated as soon as possible is that it can lead to serious complications. The complications will be apparent if medications have failed to improve your condition. This would indicate that there is a possibility that the infection has already affected one of your heart valves.

The doctor will then need to examine your heart valves and provide treatment as necessary. Treatment can include minimally invasive surgical procedure to repair a valve or replace it with an artificial one.

A successful treatment for endocarditis does not reduce the risk of the condition recurring in the future. In fact, your risks will become even higher. Endocarditis is common in patients who have a history of the condition. To lower your risks, you’ll need to make some lifestyle changes. These changes include taking preventive antibiotics before and after any type of surgery and avoiding anything that would introduce germs in your bloodstream, such as dental extractions, injections, and illegal drug use.

You’ll also need to take care of your teeth better and your health in general. By taking care of your health and undergoing preventive checkups, you’ll lower the risk of needing surgery or dental extractions or other dental surgical procedures.

References:

  • Baddour LM, Freeman WK, Suri RM, Wilson WR. Cardiovascular infections. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 64.

  • Fowler VG Jr, Scheld WM, Bayer AS. Endocarditis and Intravascular Infections. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2009; chapt 77.

  • Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007 Oct 9;116(15):1736-54.

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