Endocarditis

1 What is Endocarditis?

Endocarditis is the infection of the inner lining of the heart called endocardium. Usually, the valves of the heart are also affected. Endocardium lines the insides of the heart and is normally sterile or void of any bacteria.

The bacteria that causes endocarditis often comes from other areas of the body, like the mouth that spreads to the bloodstream. If there are damaged areas to the endocardium of the heart, bacteria is likely to get stuck there, cause infection and result to endocarditis.

Endocarditis is a serious condition that can destroy heart valves and cause life-threatening complications. Doctors treat endocarditis with medicines and, for certain cases, surgery.

As there is a need for some damage in the heart to cause infection, endocarditis is somewhat uncommon in people with healthy hearts. Endocarditis tends to be a risk or complication to patients with heart defects, problems with heart valves and those who have artificial heart valves.

2 Symptoms

Endocarditis symptoms tend to vary among patients, and may develop suddenly or slowly.

Here are the symptoms of endocarditis:

  • Changes in heart sound like new or changed heart murmur
  • Fever with chills
  • Muscles and joint pains
  • Sweating profusely at night (night sweats)
  • Fatigue or lack of energy
  • Unexplained weight loss
  • Persistent cough
  • Shortness of breath
  • Paleness of the face and skin
  • Swelling in the abdomen, legs or feet
  • Having petechiae, or tiny red or purple spots under the skin, whites of the eyes, and insides of the mouth
  • Pain or tenderness below the rib cage, indicating enlarged spleen. The spleen is the organ that helps the body fight infection.
  • Blood in your urine, which can be visible by having pink or grossly bloody urine, or seen only in urine tests
  • Presence of Osler’s nodes, or the red or purple spots under the skin of the fingers

See the doctor right away if you have one or more of these symptoms, especially if you have heart defects or heart disease, have previous histories of endocarditis and heart surgery.

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3 Causes

Endocarditis is caused by bacteria, fungi or other microorganisms attaching to the valves and damaged areas of the heart. Bacteria or other microorganisms that enter the bloodstream is very likely to go the heart.

Bacteria can enter the bloodstream in several ways:

  • The most likely route is through the mouth or oral cavity. There are plenty of blood vessels in the oral cavity, and bacteria can likely enter from cuts or wounds in the gums due to brushing or flossing, especially if the gums are inflamed or swollen. Take note that dental work can also allow bacteria in the mouth to enter the bloodstream.
  • Bacteria or other microorganisms that cause infectious or inflammatory diseases can enter the bloodstream and cause endocarditis. Some causes are bacterial skin infections, sexually transmitted disease and inflammatory bowel disorders.
  • Use of catheters and needles can allow bacteria to enter the blood vessels, especially if rules of cleanliness are not observed. This also includes tattooing and body piercings. This can also happen by using contaminated needles, syringes and intravenous sets used for administering medications.

In case bacteria do enter the bloodstream, the immune system is usually able to destroy them. Also, the turbulence and intense pressures inside the heart’s chambers prevent most bacteria from attaching so they often just pass through.

Endocarditis often develops in individuals with diseased or damaged heart valves. Diseased heart valves tend to have roughened surfaces, which tends to ‘catch’ bacteria and allow it to multiply.

4 Making a Diagnosis

For endocarditis, you are likely to see a family doctor or a cardiologist (a doctor specializing in heart conditions) to receive a diagnosis.

Here are important things you can do to improve your care:

  • List down all experienced symptoms, including ones that do not seem to be related to heart disease. Note the symptoms you may have experienced before.
  • Take with you all documents and information related to your health care. List past health problems, treatments and medications were taken, including over-the-counter ones and supplements.
  • Have a family member or spouse to come with you so you can help remember and have assistance if needed.

You can ask questions to your doctor.

Here are some good questions to ask:

  • What could be the cause of my symptoms?
  • What are the tests needed? Are there any preparations?
  • When will I start to feel better?
  • What could be the side effects of treatment? What are the long-term risks?
  • How often are the follow-ups needed for my condition?
  • If I have other medical problems, how can I manage my condition?

During appointment, your doctor may discuss with you the following:

  • Your symptoms, including the difficulty of breathing, infections, fever, heart murmurs and losing weight, and their onset.
  • History of having the same symptoms in the past.
  • If you have any medical or dental procedures that used needles or catheters.
  • History of illegal drug use.
  • If any of your first-degree relatives like parents, siblings and cousins have heart conditions

5 Treatment

Endocarditis is treated with medicines and, for certain cases, surgery.

Endocarditis involves infection, so doctors’ first course is to administer antibiotics to kill bacteria.

For endocarditis, high doses of antibiotics are given. Blood tests are done to identify the cause of infection, and to choose the appropriate antibiotic or combination of antibiotics.

The antibiotics are given for two to six weeks, sometimes longer, to clear the infection.

You may be permitted to go home once fever and other severe symptoms have passed, and antibiotics will be given to you intravenously during visits to the doctor’s office. For obvious reasons, you need to visit your doctor regularly to have medication and monitor progress of treatment.

During treatment, you need to go to the hospital immediately and call your doctor if you experienced the following:

  • Fever or chills
  • Muscle or joint pains, rash or itching, which may indicate adverse reaction to an antibiotic
  • Shortness of breath
  • Diarrhea
  • Shortness of breath
  • Swelling of the hands, legs, ankles or feet, which can indicate heart failure

Surgery is an option for endocarditis to repair severely damaged heart valves. It is also an option if endocarditis comes back repeatedly despite treatment, or is caused by fungal infection. The damaged heart valves are replaced with a new valve, which can be artificial, made from animal tissue or synthetic materials.

6 Prevention

The best way to prevent Endocarditis is to avoid all instances of infection, and to maintain proper dental and physical health.

Preventive antibiotics

If you have a history of endocarditis, you may need to take preventive antibiotics before undergoing certain medical and dental procedures. The antibiotics will help destroy bacteria or microorganisms to prevent endocarditis.

This is important because endocarditis is often more severe in people who had it before and those with a history of other heart conditions.

You may be given antibiotics before having the following procedures:

  • Dental procedures that require incisions in your gums or part of the teeth
  • Surgeries in the respiratory tract, for infection of the skin, or tissues connecting muscles to the bone

Although commonly done before, administration of preventive antibiotics is not a routine today for common dental procedures (like teeth cleaning or whitening) and surgeries in the digestive tract and urinary tract.

7 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with endocarditis.

Having endocarditis requires certain precautions on the part of health workers to avoid jeopardizing your health.

You have to let all your health care providers know about your history of having endocarditis.

You can also request an endocarditis alert wallet card from the American Heart Association.

8 Risks and Complications

There are several risks associated with endocarditis.

Healthy hearts are fewer tendencies to develop endocarditis, though it is still a possibility.

Here are the conditions that increase risk of endocarditis:

  • Congenital heart defects, which may involve problems in the heart lining and heart valves
  • Artificial heart valves, which are more likely to attract bacteria than normal heart valves
  • Damaged or diseased heart valves
  • Previous history of endocarditis, which may cause damage to heart tissues that increase risk
  • Use of intravenous illegal substances. Injecting through the vein is a fast way to introduce bacteria into the bloodstream.

If you have these conditions, discuss your doctor about your risk of having endocarditis and what can you do to prevent it.

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