Endocarditis

Overview

Endocarditis is a condition where the thin lining covering your heart’s inner chambers and valves, called the endocardium, becomes infected or inflamed. This inflammation typically happens when bacteria or other germs enter your bloodstream and attach to the heart valves, potentially causing serious damage. You must know that endocarditis is a serious infection requiring urgent treatment. Quick diagnosis and fast treatment are vital to prevent lasting harm to your heart. While this condition is rare, your risk increases if you already have issues with your heart valves or have artificial valves.

Inside your heart, delicate valves work to ensure blood flows in the correct direction. When you develop endocarditis, germs stick to these valves, forming clumps called “vegetations.” These clumps do not just damage the valves; they can also break off and travel to other parts of your body, leading to severe complications like stroke. Therefore, protecting the health of your heart’s inner surface is incredibly important for your overall well-being.

Symptoms

Endocarditis symptoms often mimic the flu, but they are persistent and worsen over time instead of getting better. The most common endocarditis sign is an unexplained fever that lasts for several weeks, often coming and going throughout the day. Other major signs include night sweats, fatigue, and unexplained weight loss. You should take these signs seriously and must see a doctor, especially if you experience a persistent fever. Paying attention to these chronic, widespread symptoms helps your doctor understand that an infection is setting up residence in your heart.

As the infection progresses, endocarditis symptoms can become more specific and signal serious complications, which means you need immediate medical help:

• Persistent Fever: A high temperature that lasts for more than a few days and does not respond to simple fever reducers.
• Overwhelming Fatigue and Weakness: Feeling excessively tired and drained of energy, even after resting.
• Night Sweats: Episodes of intense sweating while sleeping that soak your clothes and bedding.
• New Heart Murmur: Your doctor detects a new or changing sound in your heart when listening with a stethoscope.
• Small Blood Spots: Tiny red or purple spots that appear under your fingernails, on your skin, or in the whites of your eyes.
• Aches and Pains: Unexplained joint and muscle pain, especially in your back and larger joints.

Causes

Almost always, the cause of endocarditis involves bacteria, or sometimes fungi, entering your bloodstream. These germs, which normally live harmlessly in your body, can enter your blood easily during activities like aggressive tooth brushing, getting a cut, or during a medical procedure. While healthy heart valves clear these germs without a problem, if you have damaged or artificial valves, the germs can easily attach and multiply. You should be aware that any infection in your body has the potential to reach your bloodstream, which is the necessary path for the infection to reach the heart lining.

The processes that allow bacteria and other microbes to reach the inner surface of your heart and lead to endocarditis causes typically include:

• Dental and Oral Health Problems: Infections in your mouth or an abscess are one of the most common ways that germs enter your bloodstream.
• Medical Procedures: A temporary release of bacteria into the blood can happen during procedures like tooth extractions, some surgeries, or when removing an infected catheter.
• Intravenous (IV) Drug Use: The use of contaminated needles introduces large amounts of bacteria directly into the bloodstream, posing a very high risk.
• Skin Infections: Deep or serious skin infections on your body can provide a pathway for bacteria to enter the circulation.
• Artificial Heart Valves: Having a replacement valve means your body has a foreign surface, making it easier for microbes to stick and cause infection.

Diagnosis

When you see a doctor, they confirm your endocarditis diagnosis by listening to your symptoms and heart, and then immediately ordering blood and imaging tests. The most important test is the blood culture, which searches for microbes circulating in your blood. Doctors also use an echocardiogram (echo), which is an ultrasound test, to see how much damage has been done to your heart valves. Your doctor puts these test results together with your physical findings, like fever and a new heart murmur, to arrive at the correct diagnosis.

To diagnose endocarditis and assess the severity of the infection, your doctor uses several key tools and tests:

• Blood Culture: This vital test takes a small sample of your blood to grow and identify exactly which microbe (usually bacteria) is causing the infection in the laboratory.
• Echocardiogram (Echo): This painless test uses sound waves to create a moving picture of your heart and valves, allowing the doctor to see the clumps of microbes (“vegetations”) on the valve surface.
• Transesophageal Echocardiogram (TEE): This is a more detailed type of echo where a special probe is gently passed down your throat to get a clearer image from behind the heart, which is necessary if the standard echo is unclear.
• Electrocardiogram (ECG): This test records the electrical activity of your heart and shows if the infection has affected the heart’s rhythm or electrical conduction system.

Treatment

Endocarditis treatment always begins in the hospital with high doses of antibiotics given directly into your vein. You receive the specific type of antibiotic best suited to kill the microbe identified by your doctor’s blood culture test. This antibiotic treatment usually needs to last for four to six weeks, which is a critical duration to ensure the infection is completely cleared. You stay in the hospital until the infection is under control, as this treatment aims to completely eliminate the germs from your heart.

Even after clearing the infection, endocarditis sometimes requires additional steps if the damaged heart valves are failing. The essential parts of your treatment plan include:

• Intravenous (IV) Antibiotics: Medication is delivered through a vein in your arm to kill the microbes in your bloodstream at a high concentration, which is the fastest way to control the infection.
• Surgical Intervention (If Necessary): If the infection severely damages the heart valves or if large clumps of microbes cannot be cleared with medication, your doctor performs surgery to repair the damaged valve or replace it with an artificial one.
• Fever and Pain Management: Simple fever-reducing and pain-relieving medicines are used to make you comfortable while the primary treatment focuses on eradicating the infection with antibiotics.

Risks

If left untreated or diagnosed too late, the endocarditis risks to your heart and body become extremely serious. Infected valves can become permanently damaged, making it hard for your heart to pump blood effectively, which can lead to heart failure. Furthermore, pieces that break off the clumps of microbes on the valves can travel with the blood flow to vital organs like your brain, lungs, or kidneys, potentially causing a stroke or organ damage. You must take these risks seriously and complete the entire course of treatment exactly as your doctor instructs.

These two serious complications are the primary concerns that your doctor monitors closely, as they represent the most life-threatening endocarditis risks:

• Stroke (Cerebral Embolism): This happens when pieces of bacteria (vegetation) break off the heart valve and travel to block an artery leading to your brain.
• Heart Failure: This occurs when the damaged valves begin to leak significantly, meaning your heart struggles to pump enough blood to your body, causing symptoms like swelling and severe fatigue.
• Pulmonary Embolism: If the valves on the right side of your heart become infected, pieces of the bacteria can travel to the lungs and block an artery there.
• Organ Damage: The infection can impact the blood flow to your kidneys or other organs, causing them to fail or function improperly.

Prevention

The most important step you can take for endocarditis prevention, especially if you have known heart valve issues, is to pay strict attention to your oral and dental hygiene. Regular tooth brushing, flossing, and frequent visits to the dentist are the most effective ways to keep the bacteria count in your mouth under control. Your doctor may also give you preventive antibiotics before certain medical procedures to greatly reduce the risk of infection.

If you have a history of endocarditis or have an artificial heart valve, you must strictly follow these endocarditis prevention steps recommended by your doctor:

• Maintain Excellent Oral Hygiene: Brush your teeth twice a day and floss daily. When your gums bleed, the risk of bacteria entering the bloodstream increases.
• Inform Your Dentist: Always tell your dentist about your heart condition, and take the preventive antibiotics prescribed by your doctor before cleanings or dental procedures.
• Keep Wounds Clean: Clean any cuts, scrapes, or skin wounds immediately and watch them closely for any signs of infection.
• Avoid Needles: Strictly avoid illegal intravenous drug use, as this is one of the highest-risk causes of this infection.
• Carry a Medical Alert: Carry a medical alert card or bracelet stating your heart condition, so emergency personnel know your history immediately.

When to See a Doctor

You must never ignore a prolonged and unexplained fever, and you need to know when to see a doctor for endocarditis concerns. If you have a known heart valve problem and experience a fever, chills, or unexplained fatigue lasting more than a few days, call your doctor immediately. You should especially notify your doctor if these symptoms appear shortly after a dental procedure or any surgery. Prompt action helps prevent permanent damage to your heart.

If you experience the following severe symptoms, you should go to the emergency room immediately, as they could signal endocarditis complications or other serious heart problems:

• Sudden, severe shortness of breath: This can be a sign of heart failure.
• Loss of consciousness or sudden weakness/numbness on one side of your body: This strongly suggests the risk of a blood clot (stroke) traveling to your brain.
• Chest pain: Especially new or different pain in your chest.
• Persistent, high fever: A temperature that remains high despite taking antibiotics.
• Swelling: Swelling in your ankles, feet, or abdomen, which can signal developing heart failure.

Reference: Endocarditis