What is Endocarditis?
Endocarditis is an infection or inflammation of the endocardium layer that lines the inside of the heart, particularly the heart valves. This condition usually occurs when bacteria, or more rarely fungi or other microorganisms, reach the heart through the bloodstream and settle on the heart surface. As a result of the infection, heart valves can be damaged, heart function can be impaired, and infection can spread to other organs through the bloodstream. Endocarditis is a serious disease and can be life-threatening if left untreated. Native heart valves, prosthetic heart valves, or other prosthetic materials in the heart can be exposed to infection. The mitral and aortic valves are most commonly affected, but all heart valves are at risk.
What Causes Endocarditis?
Endocarditis occurs when microorganisms that enter the bloodstream settle and multiply on the heart valves or endocardium. Under normal conditions, the body’s immune system clears these microorganisms, but the risk of infection increases in people with previously damaged heart valves or weakened immune systems. Bacterial endocarditis is the most common form, with streptococci and staphylococci being the most frequent causative agents.
Causes of endocarditis:
- Bacterial infections (especially streptococcus and staphylococcus species)
- Fungal infections (such as Candida)
- Infection following dental treatments or surgical procedures
- Rheumatic heart diseases
- Congenital heart diseases
- Prosthetic (artificial) valves
- Pacemaker infections
- Immunocompromised patients (diabetes, cancer treatment, HIV)
- Intravenous interventions such as drug injection
What are the Symptoms of Endocarditis?
Symptoms of endocarditis can range from mild to severe and usually have an insidious onset. Symptoms can sometimes be confused with flu or other infections. Subacute endocarditis can progress with vague symptoms lasting for weeks or months, while acute endocarditis presents with more severe and rapidly developing symptoms.
Symptoms of endocarditis:
- Persistent fever, chills, and sweating
- Unexplained fatigue and weakness
- Night sweats
- Loss of appetite and weight loss
- Muscle and joint pain
- Petechiae on the skin (small, red spots)
- Osler nodes on fingers and toes
- Linear hemorrhages in nail beds (splinter hemorrhages)
- Hemorrhages in the retina of the eye (Roth spots)
- Clubbing of fingers
- Shortness of breath
- Chest pain
- Swollen feet, legs, or abdomen
- Changes in consciousness
What are the Risks of Endocarditis?
If endocarditis is not treated, damage and insufficiency can develop in the heart valves, and infection can spread to other organs through the blood. The risk of embolism increases in the brain, kidneys, and lungs. Fatal risks such as heart failure and sepsis can occur. Therefore, early diagnosis and appropriate antibiotic treatment are vital.
How is Endocarditis Diagnosed?
The diagnosis of endocarditis is made through a combination of clinical findings, laboratory tests, and imaging methods. For a definitive diagnosis of the disease, standardized diagnostic criteria called Duke criteria are used. These criteria include blood cultures, echocardiography findings, and clinical symptoms.
The first step in diagnosis is taking a detailed medical history and performing a comprehensive physical examination. Heart murmur, fever, and other clinical findings increase the suspicion of endocarditis. Blood cultures are the gold standard in the diagnosis of endocarditis, and at least 2-3 sets should be taken before starting treatment. Echocardiography is the most valuable imaging method for showing vegetations and damage on the heart valves.
How is Endocarditis Treated?
Treatment of endocarditis includes long-term use of antibiotics or antifungal drugs targeted at the causative agent and surgical intervention when necessary. The aim of treatment is to eliminate the infection, prevent complications, and preserve heart functions.
Antibiotic treatment is usually administered intravenously and lasts 2-6 weeks. The choice of antibiotic is based on blood culture results and antibiotic susceptibility tests. Empirical treatment is started with broad-spectrum antibiotics until culture results are available, then continued with antibiotics specific to the causative microorganism.
Surgical treatment may be necessary in cases of severe heart failure, uncontrolled infection, large vegetations, recurrent emboli, or prosthetic valve endocarditis. Surgical intervention involves repairing or replacing the damaged valve. Throughout the treatment process, the patient’s clinical condition, infection markers, and echocardiography findings are closely monitored.
How is Endocarditis Prevented?
Antibiotic prophylaxis should be administered before dental treatments and invasive procedures in patients in risk groups. Good oral hygiene should be maintained, and risk factors should be kept under control. Early medical evaluation should be done when there are complaints such as fever in high-risk patients. Intravenous drug use should be avoided, and heart valve diseases should be regularly monitored.
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
