Endocarditis is an inflammatory condition that occurs in the thin membrane covering the inner surface of your heart (endocardium) and your heart valves. It usually occurs when bacteria or fungi that enter the bloodstream reach the heart and settle there. This condition is more commonly seen in people who have previously had heart valve disease, have artificial heart valves installed, or have congenital heart defects. If endocarditis is not diagnosed and treated in time, it can cause permanent damage to heart valves and create a life-threatening situation.
Its symptoms may begin with more general infection symptoms such as fever, chills, fatigue, and night sweats, so diagnosis can sometimes be difficult. However, it can be successfully managed with early diagnosis and proper antibiotic treatment. In this article, we will comprehensively discuss what endocarditis is, its causes, symptoms, who gets it, and diagnosis and treatment methods.
What is Endocarditis?
Endocarditis is an inflammatory infection that occurs in the membrane called the endocardium that covers the inner surface of your heart and your heart valves. It usually begins when microorganisms (bacteria, fungi) that enter your bloodstream settle on the inner surface of your heart. These microorganisms form a mass called “vegetation” consisting of clots, inflammation, and germs on your heart valves. These vegetations can disrupt the function of heart valves and cause serious complications by spreading to other parts of the body.
What Causes Endocarditis?
Endocarditis usually occurs when bacteria or fungi that enter your bloodstream reach the heart. These microorganisms can naturally be found in your mouth, skin, digestive system, or urinary tract. They can mix with blood during procedures such as dental treatments, surgeries, or intravenous drug use. Especially in people who have previous damage or a structural problem in their heart, the risk of these germs settling in the heart is higher.
Let’s examine the main causes and risk factors of endocarditis in more detail:
- Bacteria: The microorganisms that most commonly cause endocarditis are bacteria. Especially bacteria such as “Streptococcus” and “Staphylococcus” that are naturally found in your oral cavity can mix with blood during situations such as tooth extraction or severe gum inflammation.
- Intravascular Procedures: During procedures such as drug use, long-term vascular access (catheter) insertion, or hemodialysis, microorganisms can directly enter the bloodstream.
- Heart Defects: Structural defects such as congenital heart valve problems or heart wall (septum) holes create turbulence in blood flow and facilitate bacteria settling there.
- Artificial Heart Valves: Artificial valves installed in the heart may be more prone to bacterial adhesion than natural valves. Therefore, patients with artificial valves are at high risk for endocarditis.
- Dental and Skin Infections: Poorly treated dental abscesses, skin infections, or wounds can also cause bacteria to mix with blood and lead to endocarditis.
What are the Symptoms of Endocarditis?
Endocarditis symptoms vary according to the type of infection (acute or subacute) and its severity. It usually begins with general infection symptoms such as fever, chills, night sweats, and fatigue. More specific symptoms include newly appearing or changing heart murmur, shortness of breath, small red or purple spots on the skin, and joint and muscle pain. These symptoms can develop gradually, so diagnosis may take time.
Let’s examine the most common symptoms of endocarditis in detail:
- Fever and Chills: Fever is the most common symptom of endocarditis. It usually manifests as high fever and chills.
- Fatigue and Weakness: A constant feeling of fatigue and weakness due to the body fighting the infection and deterioration in heart function.
- Heart Murmur: Due to damage or vegetations on heart valves, a new heart murmur may be heard or the character of an existing murmur may change.
- Shortness of Breath: As a result of heart valves losing their function, heart failure may develop, which can cause shortness of breath during exertion or at rest.
- Skin Changes: Tender, red nodules (Osler nodules) on fingers and toes or painless red spots (Janeway lesions) on palms and soles may be seen.
- Joint and Muscle Pain: Joint and muscle pain may be experienced as a general response of the body to infection.
- Night Sweats: Excessive sweating during sleep is one of the common symptoms of infection.
Who Gets Endocarditis?
Endocarditis is usually seen in people who have previous damage or abnormality in their heart. Especially those carrying artificial heart valves, those who have previously had endocarditis, those with some congenital heart defects, and those using chronic intravascular catheters are at high risk. However, intravenous drug use is also a very important risk factor for endocarditis.
The main groups at risk for developing endocarditis are:
- Those Carrying Artificial Heart Valves: Prosthetic valves may be more prone to bacterial adhesion than natural valves.
- Those with Previous Endocarditis History: Having had endocarditis once increases the risk of recurrence.
- Those with Congenital Heart Diseases: Individuals with heart valve or septum (wall) defects are at risk.
- Intravenous Drug Users: With non-sterile needles and substances, germs directly enter the bloodstream and often settle on heart valves.
- Those with Long-term Intravascular Catheters: Those receiving dialysis treatment due to kidney failure or using long-term vascular access.
- Those with Weakened Immune Systems: The risk of infection is higher in individuals with diseases such as diabetes, HIV, or those receiving chemotherapy.
How is Endocarditis Diagnosed?
Endocarditis diagnosis is made through a combination of careful evaluation of your symptoms, physical examination, blood tests, and cardiac imaging tests. Your doctor listens for heart murmurs and looks for other signs of infection in your body. Blood cultures and echocardiogram (heart ultrasound) are vital for definitive diagnosis. These tests allow us to see both the infection and the damage to your heart valves.
The main methods used in endocarditis diagnosis are:
- Physical Examination and History: Your doctor evaluates your general symptoms such as fever and sweating and any changes in your heart murmur.
- Blood Culture: Blood samples are examined for the presence of bacteria or fungi. This test allows us to identify the microorganism causing the infection.
- Echocardiogram (Heart Ultrasound): Provides detailed images of your heart and valves. With this test, we can see vegetations on valves, valve damage, and deterioration in heart function. Both standard and transesophageal echocardiograms can be used.
- Blood Tests: Inflammatory markers such as CRP and white blood cell count, and kidney function tests are performed.
- Other Imaging Methods: In some cases, additional imaging methods such as computed tomography (CT) or PET scan may be used to see if the infection has spread to other organs.
How is Endocarditis Treated?
Endocarditis treatment aims to eliminate the infection and prevent further damage to heart valves. The foundation of treatment consists of long-term and high-dose antibiotic therapy. Since antibiotics are given intravenously, hospitalization may be required. In some cases, surgical intervention may also be necessary to clean infected tissue or repair or replace damaged heart valves.
The methods applied in endocarditis treatment are:
Antibiotic Treatment:
- High-dose intravenous antibiotic treatment is applied targeting the bacteria or fungi determined as a result of blood cultures.
- Treatment duration usually lasts 4 to 6 weeks and requires close monitoring to ensure the infection is completely cleared.
Surgical Treatment:
- If endocarditis has caused serious damage to heart valves or if the infection does not respond to drug treatment, surgical intervention may be required.
- During surgery, infected tissues are cleaned, valves are repaired, or replaced with artificial valves.
- Surgery may also be preferred in cases where vegetations are very large and the risk of embolism (clot) is high.
Supportive Treatments:
- Pain relievers and fever reducers may be used to control fever and pain.
- If heart failure develops, treatments aimed at managing this condition are also planned.
What are the Ways to Prevent Endocarditis?
The most important steps to prevent endocarditis are knowing your risk factors and paying attention to sources of infection. People with a heart condition that creates risk should pay great attention to dental hygiene, keep skin wounds clean, and inform their doctors about their medical history. Additionally, in some high-risk situations, prophylactic antibiotic use may be required before tooth extraction or surgical operations.
What you can do to reduce endocarditis risk:
- Dental Hygiene: You should pay great attention to your oral and dental health. You should brush your teeth regularly, use dental floss, and not neglect your routine dental check-ups.
- Antibiotic Prophylaxis: In cases such as heart valve disease, artificial valve, or previous endocarditis history, you should use the prophylactic antibiotic recommended by your doctor before tooth extraction or certain surgical procedures.
- Skin Care: You should keep your skin clean to prevent cuts or wounds from becoming infected.
- Care in Intravascular Procedures: If you are using a long-term vascular catheter, you should pay attention to the cleanliness and sterilization of the catheter.
- Healthy Lifestyle: To keep your immune system strong, you should eat healthily, exercise regularly, and stay away from cigarettes.
When Should You See a Doctor?
If you have a condition that creates risk in your heart (artificial valve, congenital heart disease) and you experience symptoms such as fever, chills, fatigue, shortness of breath, you should consult your doctor without delay. Especially if you have complaints such as unexplained fever, night sweats, and muscle pain, it is important to consider the possibility of endocarditis. Early diagnosis and treatment can save lives by preventing serious complications.
You need to see a doctor or emergency room immediately in the following situations:
- Unexplained High Fever: Especially fever lasting more than two days that cannot be attributed to another source of infection.
- Newly Appearing or Changing Heart Murmur: A murmur that your doctor has not previously noticed or a change in your existing murmur.
- Shortness of Breath: Sudden onset or progressively worsening shortness of breath.
- Unexplained Bleeding or Bruising in Your Body: Small, red or purple spots on the skin.
- Stroke or Stroke Symptoms: Symptoms such as weakness, numbness, or speech disorders on one side of the body may indicate that a clot that broke off from vegetation has gone to the brain.
- Night Sweats: Intense night sweats without an underlying cause.
Frequently Asked Questions
Can endocarditis be seen at any age?
Endocarditis is a disease that can occur in any age group. Although it is more common in people with heart disease or those with weakened immune systems, it can also be encountered with specific risk factors such as intravenous drug use in young people.
Can endocarditis be completely cured?
With appropriate treatment, the infection can be controlled, and the person can regain health. However, if there is permanent damage to the heart valves, additional treatments such as valve repair or replacement may be required instead of a complete recovery.
How long does it take to diagnose endocarditis?
The diagnosis time varies depending on the time it takes for blood cultures to yield results and the patient’s symptoms. While blood cultures usually give results within 2-5 days, suspicion can be confirmed on the same day with methods such as echocardiography.
Can endocarditis recur?
If underlying risk factors, such as an artificial valve or untreated sources of infection, persist, endocarditis can recur. Therefore, prevention steps are of great importance in high-risk individuals.
How does endocarditis affect organs outside the heart?
Infection can cause embolism or abscess formation through the spread of clots or microorganisms to organs such as the brain, kidneys, or lungs via the bloodstream. For example, an embolism reaching the brain can increase the risk of stroke.
Can endocarditis symptoms be confused with other diseases?
Symptoms such as fever, fatigue, and joint pain can easily be confused with other conditions such as flu or rheumatic diseases. Therefore, specific findings such as splinter hemorrhages and imaging methods play a critical role in diagnosis.
Is endocarditis related to the immune system?
Although endocarditis is not directly an immune disease, the risk of infection may increase in people with weakened immune systems (for example, cancer patients or those with autoimmune disease), and the disease may have a more severe course.
Is endocarditis contagious?
Endocarditis does not spread from person to person. However, bacteria that cause infection can spread indirectly, for example, through the skin or in poor hygiene conditions.
Can sports be done after endocarditis?
If recovery is complete and heart functions are normal, light sports can be done with a doctor’s approval. However, if there is serious valve damage, intense physical activities may pose a risk.
Reference: Endocarditis
