Endocarditis

Overview

Endocarditis is a severe condition characterized by inflammation of the inner lining, known as the endocardium, of the heart’s chambers and valves. Factors that increase the likelihood of developing endocarditis include the presence of artificial heart valves, existing damage to the heart valves, or other congenital heart defects.
If left untreated, endocarditis can lead to severe complications, particularly in the form of damage or destruction of the heart valves. Such damage can impair the heart’s ability to pump blood effectively and lead to further cardiovascular complications.
The available treatment options for endocarditis consist of both medication-based approaches and surgical interventions.

Symptoms

The symptoms of endocarditis can vary from person to person and may develop gradually or suddenly, depending on the type of germs causing the infection and the presence of other heart problems. The following are commonly observed symptoms associated with endocarditis:

• Joint and muscle aches
• Chest pain during breathing
• Fatigue or excessive tiredness
• Sweating or chills, especially night sweats
• Shortness of breath
• Swelling in the feet, legs, or abdomen
• Detection of a new or altered whooshing sound in the heart (murmur)

Endocarditis may present with less commonly observed symptoms, such as:

• Unexplained weight loss
• Presence of blood in the urine
• Tenderness experienced under the left rib cage (spleen)
• Appearance of painless flat spots on the soles of the feet or palms of the hands, which may be red, purple, or brown in color (known as Janeway lesions)
• Development of painful bumps or darkened patches of skin on the fingertips or toes (referred to as Osler nodes)
• Presence of tiny round spots on the skin (petechiae) that are purple, red, or brown in color. These spots may also occur in the whites of the eyes or inside the mouth.

If you experience symptoms of endocarditis, it is crucial to seek immediate medical attention, particularly if you have a congenital heart defect or a history of endocarditis. Other less severe conditions can present similar signs and symptoms, making a thorough evaluation by a healthcare provider essential for an accurate diagnosis. If you have already been diagnosed with endocarditis and notice symptoms such as chills, fever, headaches, joint pain, or shortness of breath, it is important to inform your healthcare provider, as these symptoms may indicate a worsening of the infection.

Causes

Endocarditis is a condition that is often caused by an infection from bacteria, fungi, or other harmful microorganisms. These germs enter the bloodstream and make their way to the heart. In most cases, bacterial infections are responsible for endocarditis. The bacteria can enter the blood during dental procedures, such as tooth extractions, or through endoscopic examinations. Normally, the immune system in our bodies can eliminate any harmful bacteria that enter the bloodstream. However, if this defense mechanism fails, it can lead to endocarditis. The bacteria quickly form colonies, grow vegetation, and release enzymes that damage the surrounding tissue, creating a pathway for further invasion. While healthy heart valves are highly resistant to infection, bacteria can attach themselves to defects on the surface of diseased valves. Replacement heart valves are more susceptible to infection compared to normal valves.

Risk factors

Endocarditis can be caused by various factors, leading to the entry of germs into the bloodstream. While having a faulty or diseased heart valve increases the risk, it is important to note that endocarditis can occur in individuals without heart valve problems. Several factors can increase the likelihood of developing bacterial endocarditis:

• Advanced age: Endocarditis is more common in adults over the age of 60.
• Artificial heart valves: Germs are more likely to attach to prosthetic heart valves compared to natural heart valves.
• Acquired valve disease: Certain medical conditions, such as rheumatic fever or infection, can damage or scar the heart valves, increasing the risk of infection. Previous occurrences of endocarditis also raise the risk.
• Congenital heart defects: Individuals born with certain types of heart defects, including irregularities or damaged heart valves, have a higher risk of heart infections.
• Implantable devices: Bacteria can attach to implanted devices like pacemakers, leading to an infection of the heart’s lining.
• History of bacterial endocarditis: Individuals who have had endocarditis in the past are at an increased risk of developing it again.
• Suppressed immune system: People with weakened immune systems are more susceptible to infections, including endocarditis.
• Intravenous (IV) drug use: Using contaminated IV needles can lead to infections such as endocarditis. Individuals who use illegal IV drugs, like heroin or cocaine, face a particular risk due to the use of unsterilized equipment.
• Poor dental health: Maintaining good oral hygiene is crucial for overall health. Neglecting regular brushing and flossing can allow bacteria to grow in the mouth, potentially entering the bloodstream through cuts on the gums. Certain dental procedures that involve cutting the gums also pose a risk of introducing bacteria into the bloodstream.
• Long-term catheter use: Endocarditis risk is heightened when an indwelling catheter, which is a slender tube employed for various medical procedures, remains in place for an extended duration.