Infective endocarditis (IE) is a dangerous disease that occurs more often in the elderly, may cause other symptoms, and the management and prognosis of seniors are also different. It is worth finding out what exactly these differences are and what they result from.
Infective endocarditisis a disease that develops as a result of infection of the endocardium, i.e. the lining of the heart and valves, as well as implanted materials (such as artificial valves or pacemaker electrodes). Many factors predispose to the development of infection, including:
- having a rheumatic disease
- valvular disease
- presence of foreign materials
All of them in a different mechanism constitute the basis for "sticking" of bacteria, and this directly causes disease.
Of course, immune disorders also increase the risk of getting sick.
As you can easily guess, the occurrence of the above-mentioned factors is more common in older people, who are usually "more sick".
This leads to a situation where the most patients with IE are over 70 years of age, and more than half of endocarditis cases occur after the age of 60.
Such people usually have many cardiovascular diseases: valvular defects, ischemic heart disease, arrhythmias, their occurrence is often associated with the necessity of cardiac surgery, pacemaker implantation and many other procedures, some of which predispose to endocarditis.
Recently, there has been an increased number of IE associated with degenerative valve changes, which occur mainly in seniors, e.g. aortic stenosis, which is particularly common.
In addition, it has been noticed that other diseases, not related to the circulatory system, also increase the risk of endocarditis, they are:
- diabetes
- urinary tract cancer
- cancers of the gastrointestinal tract
It is obvious that they mostly affect seniors.
Infective endocarditis symptoms and diagnosis
The symptoms of IE are very unusual and occur in many other diseases, including:
- high fever
- chills
- persistent low-grade fever
- excessive sweating
- generalweakening
- lose weight
- joint pain
Of course, there may be all or only some of them. Less common and less specific symptoms are:
- paresis
- behavior change
- stomach pains
- visual disturbance
- chest pains
- skin changes
- recurring pneumonia
Occasionally, abnormalities in the medical examination are also observed, e.g. newly diagnosed heart murmurs being a symptom of valve damage.
In the elderly, the symptoms of IE are particularly common, which is why they are attributed to other diseases.
In seniors, endocarditis quite often causes symptoms such as depression, paralysis or hallucinations, they are very rarely associated with IE and the cause is sought in neurological diseases.
Diagnosis of infective endocarditis
The diagnosis of infective endocarditis includes a number of tests, mainly echocardiography - a transthoracic examination, and if necessary, also a transesophageal examination. Performing this test is crucial in making an accurate diagnosis, but also necessary to assess whether the valves are infected with an infection, whether their function is damaged by bacteria, and how advanced the disease is.
In the case of echocardiographic diagnosis, it is also difficult in the elderly, which is due to, on the one hand, the common degenerative changes in the valves, which makes the correct interpretation of the echocardiographic image difficult. Another factor influencing this assessment is lung disease or the presence of materials inside the heart (valves, electrodes).
The next tests performed in the case of suspicion of IE are:
- blood culture, in which it is possible to detect and identify the bacterium responsible for the disease, and therefore appropriately select antibiotic therapy
- laboratory tests: inflammatory markers (elevated), peripheral blood counts (mainly increased white blood cells)
- Chest X-ray in case of suspicion of accompanying pneumonia
- computed tomography, not essential, but can confirm changes seen in echocardiography
Treatment and prevention of infective endocarditis
Treatment of infective endocarditis is based on intravenous administration of antibiotics, the therapy usually lasts several weeks, and its length depends on the type of pathogen and the underlying disease.
Adequate treatment is particularly difficult in the elderly, on the one hand it isthe need to use antibiotics to which bacteria are sensitive, but also taking into account the possible occurrence of renal failure or liver failure and the related contraindications to the use of many drugs.
Another method of treatment is invasive treatment. Surgery is performed if damage to the valve significantly impairs its function and if antibiotic therapy is ineffective. In the case of infection related to an implanted device (stimulator), it is usually necessary to remove it.
There are known factors that strongly increase the risk of infective endocarditis, they are:
- presence of an artificial valve
- previous endocarditis
- congenital, so-called cyanosis, heart defect
In such cases, prophylactic administration of antibiotics is necessary before dental procedures.
ImportantInfective endocarditis is a serious disease at any age. This disease occurs especially often in the elderly, it results from the presence of many factors contributing to IE, which in turn is associated with the presence of other diseases that predispose to this condition. The most important factor contributing to the disease is the presence of a substrate, or so-called foreign material, in the heart. Unfortunately, in the elderly, not only diagnosis but also treatment is difficult. All this translates into a worse prognosis in seniors suffering from IE.
About the author
Bow. Maciej GrymuzaA graduate of the Faculty of Medicine at the Medical University of K. Marcinkowski in Poznań. He graduated from university with an over good result. Currently, he is a doctor in the field of cardiology and a doctoral student. He is particularly interested in invasive cardiology and implantable devices (stimulators).