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Endocarditis is a disease in which the lining of the heart becomes inflamed. Late diagnosis can lead not only to heart failure, but also to the central nervous system, and even life-threatening sepsis. What are the causes and symptoms of infective endocarditis? What is the treatment for this heart disease?

Endocarditis ( IE ) is a disease in which inflammation affects the membrane that lines the surface of the heart cavities and covers the valves, as well as large blood vessels in the chest and foreign objects in the heart , for example, valvular prostheses or pacemaker electrodes. Infectious endocarditis can damage the structures of the heart, mainly the valves, as well as peripheral embolism, which can lead to heart attacks, abscesses or inflammation of other organs.

Endocarditis - causes and risk factors

90 percent In cases of endocarditis, bacteria (less often fungi, chlamydia and mycoplasmas) present in the body, mainly streptococci, as well as staphylococci, enterococci and gram-negative bacteria, are the cause of endocarditis.

Bacteremia (blood contamination with bacteria) occurs as a result of the disruption of the continuity of the mucous membranes, most often during dental procedures.

Bacteria can also enter the circulation during procedures in the gastrointestinal, respiratory or genitourinary systems, but also during everyday activities, such as brushing teeth or chewing food. For their invasion and development of inflammation, the endocardium must be damaged, i.e. the endothelium is interrupted and a thrombus is formed. Normal endothelium of the endocardium is a barrier for them and prevents colonization and development of inflammation.

People with:

are primarily at risk of endocarditis
  • history of rheumatic disease (not to be confused with rheumatoid arthritis)
  • congenital heart disease
  • acquired heart defects
  • mitral valve prolapse with regurgitation
  • other heart diseases (including hypertrophic cardiomyopathy, ischemic heart disease)
  • heart valve prostheses

Other factors that increase the risk of IE includeamong others :

  • old age
  • immunodeficiency
  • conditions favoring the formation of clots on the surface of the damaged endocardium (e.g. cancer, leukemia)

IE is also one of the complications of drug addicts injecting drugs.

Endocarditis - symptoms

Initially, symptoms appear that are characteristic of all inflammations in the body, i.e.

  • increased body temperature
  • weakness
  • sweating
  • headaches
  • muscle and joint pain
  • lack of appetite
  • pains in the chest or abdomen
  • back pain

Only with the development of the disease, more characteristic symptoms appear, depending on which part of the heart (left or right) is inflamed. In the case of inflammation of the right atrium, the right ventricle and the emerging pulmonary trunk, symptoms resembling pneumonia appear, namely:

  • chills
  • fever
  • night sweats
  • weakness
  • shortness of breath
  • cough
  • chest pain

In the case of the involvement of the left heart, symptoms of peripheral circulatory disturbance in the form of embolism dominate. Typical symptoms of embolism are petechiae on the skin, linear petechiae under the fingernails resembling a stuck in a splinter, and Osler's nodules, i.e. painful swellings on the fingers and toes.

Symptoms of left ventricular failure may also appear (e.g. dyspnoea, easy fatigue). Regardless of which part of the heart was affected, auscultation detects murmurs the nature of which depends on the location of the lesions.

In the course of the disease, inflammation may also spread throughout the body. For example, when the central nervous system is affected, neurological disorders may occur, and when renal arteries are involved, symptoms of renal failure and pain in the lumbar region may arise. In turn, spleen infarction is characterized by upper abdominal pain on the left side.

Ww. symptoms may begin within days of onset of inflammation. Endocarditis can also be a chronic disease. It then develops insidiously, causing chronic inflammation. In this case, the patient is usually prescribed various medications that change the picture of the disease, making it difficult and time-consuming to make an accurate diagnosis.

Important

Endocarditis can lead to sepsis

Endocarditis is the result of blood poisoning,that is, it is in fact sepsis. Therefore, if left untreated, it can lead to death. When microbes enter the blood, they reach every corner of the body and can quickly lead to failure of internal organs, starting with the heart.

Endocarditis - diagnosis

The basic diagnostic test is blood culture, the purpose of which is to detect the presence of bacteria in the body.

Another very important test is echocardiography (echo of the heart), thanks to which it is possible to visualize changes in the structure of the valves and their consequences in functioning (e.g. blood leakage).

In turn, electrocardiography (EKG) allows to detect changes resulting from endocarditis, e.g. ischemic changes.

Endocarditis - treatment

Antibiotic therapy is used to treat endocarditis. Antibiotic therapy is conducted in a hospital and lasts 4-6 weeks. If inflammation is not controlled or the valves are too severely damaged, cardiac surgery is required. It involves the removal of inflamed tissues, repair of valves or implantation of valve prostheses.

Endocarditis - how to prevent it?

Antibiotic prophylaxis is extremely importantduring various medical procedures in people at risk, i.e. people with valvular prostheses, cyanotic heart defects and those who have already had IE in the past.

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Category:

Cardiology