Endocarditis: Symptoms, Diagnosis & Treatment

Endocarditis

Endocarditis, also known as infective endocarditis can be life-threatening and cause inflammation of the wall of the chambers as well as valves (endocardium).

Endocarditis usually occurs due to an infection. Bacteria, fungi, or other bacteria that come from another part within your body like your mouth, can travel throughout your bloodstream, and then attach to damaged parts of your heart. If not addressed promptly, endocarditis could harm or ruin the heart valves. Treatments for endocarditis can include medication and, occasionally, surgical intervention.

People who are most susceptible to endocarditis are those with damaged heart valves or artificial heart valves. other heart defects¹.

 

Symptoms

The development of endocarditis can be slow or abruptly, depending on the germs that are responsible for the infection and if there are any existing heart issues. The signs and symptoms of endocarditis may differ from one person to the next.

The most common indications and signs of endocarditis are:

• Muscles and joints that are aching
• The chest hurts when you breathe
• Fatigue
• Influenza-like symptoms, like chills and fever
• Night sweats
• Breathing shortness
• Inflammation in your legs, feet or stomach
• A new or modified heart murmur that is the sound of your heart created by the blood flowing through your heart

Common signs and symptoms of endocarditis could be:

• Unexplained weight loss
• The blood in your urine that you may be able observe or your doctor could be able to see when he examines your urine under microscope
• The spleen is tender that is an anti-infection organ that is located beneath your left rib cage
• The heels of your feet, or your palms (Janeway lesions)
• The tender, red spots are located under the skin toes and fingers (Osler’s nodes)
• Tiny red or purple spots, referred to as petechiae  located on the skin, within the eye’s whites or in the mouth.

When should you seek medical help?

If you are experiencing symptoms or signs of an endocarditis you should see your doctor immediately and especially in the event that you have risk factors for this serious infection like an abnormal heart or a previous history of endocarditis. While less serious ailments may produce similar symptoms and signs but you can’t be certain until you’ve been evaluated by your physician.

When you’ve received a diagnosis of an endocarditis infection, discuss with your doctor any symptoms or signs that could indicate your condition is becoming worse, including:

• Chills
• Fever
• Headaches
• Joint pain
• Breathing shortness
• Rash

If you’re receiving antibiotics for endocarditis, inform your doctor if there is diarrhea or a rash, joint pain or itching. These symptoms and signs could indicate that you’re experiencing a reaction to the prescribed antibiotic.

Causes

The term “endocarditis” refers to the situation when bacteria, typically infiltrate your bloodstream. They move to your heart and then attach to heart valves, or damaged tissue. Other germs or fungi could cause endocarditis.

Usually the immune system is able to eliminate all harmful bacteria that get into your bloodstream. However, the bacteria that reside in your throat, mouth or in other areas that are part of you, including your skin or your digestive tract may result in endocarditis under certain conditions.

Bacteria, fungi, and other bacteria that cause endocarditis could get into your bloodstream through:

• Dental care that is not properly done. Proper toothbrushing and flossing can help prevent gum disease. If you don’t take proper care of your gums and teeth cleaning them can cause unhealthy gums to leak, which could give bacteria the opportunity to get into your bloodstream. Certain dental procedures that cause gum bleeding also let bacteria be introduced into your bloodstream.
• Catheters. Bacteria can enter your body through a small tube that doctors may employ to inject or eliminate fluid from your internal organs (catheter). This can happen if the catheter is placed for a prolonged duration of duration. As an example, you could be fitted with a catheter if require dialysis for a long time.
• Illegal use of IV drugs. Contaminated needles and Syringes are of particular concern for people who take illicit IV drugs like cocaine or heroin. Most people who use these kinds of drugs do not are able to access clean, un-used needles or Syringes.

Risk factors

It is more likely that you will develop endocarditis if you suffer from faulty or damaged or diseased heart valves. But, it can also occur in people who are otherwise healthy.

There is a higher risk of contracting endocarditis when you are:

• Aged older. Endocarditis occurs most often in people over 60 years old.
• Artificial valves for the heart. Germs are more likely to be attached on the artificial (prosthetic) heart valve than to a regular heart valve.
• Heart valves damaged. Certain medical conditions such as infections or rheumatic fever can cause scarring or damage to the one or several of your heart valves, thereby increasing the chance of contracting an infection.
• Congenital heart problems. If you were born with certain kinds of heart defects, like an abnormal heart or valves for your heart, ventricular septal defect,  you could be more susceptible to an infection.
• Heart implanted devices. Bacteria can attach to implanted devices, for example, a pacemaker leading to an infection of the heart’s liner.
• An endocarditis history. Endocarditis can damage the heart valves and tissue and increase the risk of developing a heart attack in the future.
• A record of illegal IV drug usage. People who use illegal drugs through injection are at greater risk of developing endocarditis. The needles used for injecting drugs may be contaminated with the bacteria that cause endocarditis.
• Dental health is poor. A healthy mouth and healthy gums are vital to good health. If you don’t brush or floss frequently, bacteria could develop inside your mouth and can get into your bloodstream via an injury to the gums.
• The use of long-term catheters. Having a catheter on the market for a prolonged amount of time (indwelling catheter) increases the chance of contracting endocarditis.

In the event that you’re in danger for developing endocarditis be sure to let your physicians be aware. It’s possible to request an endocarditis wallet card through the American Heart Association. Find your local chapter, or print the card through the website of the association.

Complications

In the case of endocarditis, clumps of cells and germs create an abnormal mass inside your heart. The clumps, also known as vegetations, may break loose and then travel to your lungs, brain organs in your abdomen kidneys, legs and arms.

This is why endocarditis can lead to a variety of complications, for example:

• Heart issues, like heart murmurs, heart valve injury and heart failure
• Stroke
• Pockets of pus (abscesses) which develop in the brain, heart the lungs, and various organs
• A blood clot is formed in the blood vessel in the lung (pulmonary embolism)
• Kidney damage
• Larger spleen

Prevention

Follow these steps to avoid endocarditis:

• Be aware of the symptoms and signs for the condition known as endocarditis. See your doctor immediately if you experience any symptoms or signs particularly an unresolved fever that doesn’t disappear, a feeling of fatigue that isn’t explained or any skin infection, or sores or cuts that don’t heal in a timely manner.
• Make sure you take care of your teeth as well as your gums. Brush and floss your gums and teeth frequently and get regular dental check-ups. Dental hygiene is essential to keeping your overall health in good shape.
• Don’t take unapproved IV medicines. Dirty needles can introduce germs into the bloodstream which can increase the risk of developing endocarditis.

Antibiotics that prevent infection

Certain dental or medical procedures could let bacteria into your bloodstream.

If you’re at a high risk of developing endocarditis, American Heart Association recommends taking antibiotics at least an hour prior to getting any dental procedure performed.

There is a higher risk of developing endocarditis and require antibiotics prior to your dental procedure If you suffer from:

• An endocarditis history
• Man-made (prosthetic mechanical) heart valve
• A heart transplant can be performed in certain instances
• Certain kinds of heart diseases congenital
• Heart disease surgery for congenital causes within the last six months

If you are suffering from endocarditis, or another type of congenital heart disease, speak to your dentist or doctor about the risks you face and whether you’ll need preventive antibiotics.

Diagnosis

Your doctor will take into consideration the medical history of you, symptoms and signs, as well as the results of your tests when making an endocarditis diagnosis. The diagnosis will usually be dependent on a variety of variables instead of just a single positive test result or a symptom.

Tests to rule out or confirm endocarditis can include:

• Test for blood culture. A blood culture test can be used to determine any bacteria present in your bloodstream. Results from a blood culture test aid your doctor in choosing the most effective antibacterial or antibiotic combination.
• A complete Blood count. This blood test will inform your doctor if you are surrounded by white blood cells. This could be an indication of an infection. Complete blood counts may aid in determining the presence of the presence of low amounts of red blood cells (anemia) and could be an indication of endocarditis. Other blood tests may also be performed to assist your physician in determining the type of diagnosis.
• Echocardiogram. The echocardiogram makes use of sound waves to generate pictures of the heart when it is beating. This test reveals the chambers of your heart and how valves are moving the blood around your body. Your doctor could utilize two different kinds of echocardiograms to aid in diagnosing endocarditis. In a transthoracic echocardiogram sound waves directed towards your heart by a wand-like device (transducer) that is placed on your chest generate videos of your heart’s motion. The test allows your doctor to examine the structure of your heart and assess it for evidence of damage.Transesophageal echocardiograms allow your doctor a better view of your heart’s valves. In this procedure, a tiny transducer that is attached to the tube’s end is placed into the tube that connects the mouth towards the stomach (esophagus). This test offers more precise pictures of the heart that are feasible with transthoracic echocardiogram.
• Electrocardiogram (ECG or EKG). An ECG The test is used to gauge the frequency and duration of the heartbeats. It’s not used specifically to diagnose endocarditis but it could tell your doctor whether something affects the electrical activity of your heart. During an ECG Sensors that detect the electrical activity of your heart are connected to your arms, chest and legs.
• Chest Xray. A chest X-ray will show your doctor the state of your lungs and your heart. It will help determine if you have suffered from endocarditis that has caused the heart to swell or if the infection has reached the lung.
• Computerized Tomography (CT) scans or magnetic resonance images (MRI). You might need to get the help of CT scan or MRI scan of your chest, brain or other areas of your body, if your doctor believes that an infections have spread to these regions.

Treatment

A lot of people suffering from endocarditis can be successfully treated by antibiotics. Sometimes, surgery might be needed to repair or repair damaged heart valves, and remove any symptoms of the infection.

Medications

The kind of medication you take depends on the condition at the root of the issue.

The high levels of IV anti-biotics can be used to treat endocarditis that is caused by bacteria. If you are treated with the IV treatment, expect to usually be spending a week or more in the hospital, so that your doctor can confirm if your treatment is effective.

If your fever and obvious signs or symptoms are gone and you’re able quit the hospital and carry on IV antibiotics by visiting your doctor’s office or your home using home care. It is common to take antibiotics for some time to treat the infection.

If the cause of endocarditis is an infection that causes fungal inflammation the doctor will prescribe antifungal medications. Certain people require lifelong antifungal medication to prevent endocarditis from coming back.

Surgery

The procedure of repairing the heart valve is required to treat chronic endocarditis or to replace the damaged valve. Surgery is sometimes also required to treat endocarditis caused by a fungal infection.

In the event of a medical condition depending on your condition, your doctor may suggest fixing your damaged valve, and replacing the valve with a replacement valve that is made of human, cow or pig cardiac tissue (biological tissue valve) or man-made substances (prosthetic mechanical valve).