Endocarditis is an inflammation or infection of the endocardium, which is the inner lining of the heart muscle and, most commonly, the heart valves. It is usually caused by bacterial infection, but can be caused by fungus.
Alternative Names of Endocarditis are: Valve infection.
Complications of Endocarditis
Endocarditis can cause several major complications:
Stroke and organ damage. In endocarditis, clumps of bacteria and cell fragments (vegetations) form in your heart at the site of the infection. These clumps can break loose and travel to your brain, lungs, abdominal organs, kidneys or extremities. This may cause various problems, including stroke or damage to other organs or tissues.
Infections in other parts of your body. Endocarditis can cause you to develop pockets of collected pus (abscesses) in other parts of your body, including the brain, kidneys, spleen or liver. An abscess may develop in the heart muscle itself as well, causing an abnormal heartbeat. Severe abscesses may require surgery to treat them.
Heart failure. Left untreated, endocarditis can damage your heart valves and permanently destroy your heart's inner lining. This can cause your heart to work harder to pump blood, eventually causing heart failure — a chronic condition in which your heart is unable to pump enough blood to meet your body's needs. If the infection progresses untreated, it's usually fatal.
Causes of Endocarditis
In infective endocarditis, the bacteria cluster on and around the heart valves; this may impair their ability to function properly. Although bacterial endocarditis may occur in anyone at any time, it is unusual in persons who do not have valvular heart disease.
Valves deformed by a previous attack of rheumatic fever were once a major predisposing factor, but this is less so today since rheumatic fever has become much less common.
Other predisposing factors include artificial heart valves, some congenital heart disorders, hypertrophic cardiomyopathy, and mitral valve prolapse with regurgitation. People with such risk factors are more likely to develop endocarditis when exposed to an infection from any source.
Dental surgery, urologic or gynecologic surgery, colonoscopy, and skin infections increase the risk of endocarditis, even if there is no pre-existing anatomic valve deformity.
Intravenous drug users are also at significant risk.
Signs & Symptoms of Endocarditis
The acute form of endocarditis may cause more severe symptoms, while symptoms of the chronic form may be milder, making it more difficult to diagnose.
Symptoms of bacterial endocarditis may include fever, fatigue, loss of appetite, night sweats, chills, headaches, joint discomfort, and tiny pinpoint-sized hemorrhages on the chest and back, fingers, or toes. Upon examination, the physician may also detect a new heart murmur and small hemorrhages in the mucous membranes of the eyes.
Diagnosis of Endocarditis
Diagnosis is usually suspected based upon the patient's history, symptoms, and findings such as a new murmur. It may be confirmed by blood tests (blood cultures) to identify an infectious organism. An echocardiogram (an ultrasound study of the heart muscle and valves) may be helpful in identifying a clump of bacteria on the heart valve.
Treatments of Endocarditis
Bacterial endocarditis almost always requires hospitalization for antibiotic therapy, generally given intravenously, at least at the outset. Occasionally, therapy with oral antibiotics at home will be successful. Antibiotic therapy usually must continue for at least a month. Most patients respond rapidly to institution of appropriate antibiotics, with over 70 percent of patients becoming afebrile (without a fever) within one week. In unusual cases, surgery may be necessary to repair or replace a damaged heart valve.
Prevention of Endocarditis
It is important that you mention to your physician or dentist any risk factors you may have for endocarditis. Those who have any predisposing factors for bacterial endocarditis (including prosthetic heart valves, previous bacterial endocarditis, congenital heart disease, rheumatic valve dysfunction, hypertrophic cardiomyopathy, and mitral valve prolapse with valvular regurgitation) should be given antibiotics before most medical or dental surgeries and whenever any significant skin infection occurs. Your physician will recommend which antibiotic(s) to take before, and in some cases, after your procedure.
When to seek Medical Advice
If you develop signs or symptoms of endocarditis, see your doctor right away — especially if you have risk factors for this serious infection. Signs and symptoms may include:
A new or changed heart murmur
Aching joints and muscles
Shortness of breath
Swelling in your feet, legs or abdomen
Unexplained weight loss
Blood seen during microscopic examination of your urine
Tenderness in your spleen — an infection-fighting abdominal organ on your left side, just below your rib cage
Although less serious conditions can cause similar signs and symptoms, you won't know for sure until you see a doctor.