Infective endocarditis

Overview

Endocarditis is a life-threatening inflammation of the endocardium (inner lining of the heart's chambers and valves).

Endocarditis is usually caused by an infection. Bacteria, fungi or other germs get attached to damaged areas in the heart. If it's not treated quickly, endocarditis can damage or destroy  heart valves. Treatments for endocarditis include medications and, sometimes, surgery.

People at greatest risk of endocarditis are the ones who have damaged heart valves, artificial heart valves or other heart defects.

Signs and symptoms

Aching joints and muscles

Chest pain when you breathe

Fever

Swelling in  feet, legs or abdomen

A new or changed heart murmur

Red spots on the soles of feet or the palms of hands (Janeway lesions)

Red, tender spots under the skin of your fingers or toes (Osler's nodes)

Causes

Endocarditis occurs when germs, usually bacteria, enter the bloodstream, travel to the heart, and attach to abnormal heart valves or damaged heart tissue

Improper dental care - Proper toothbrushing and flossing helps prevent gum disease. Unhealthy gums can bleed, giving bacteria a chance to enter the bloodstream. 

Catheters - This is more likely to occur if the catheter is in place for a long period of time. For example, you may have a catheter if you need long-term dialysis.

Illegal IV drug use - Contaminated needles and syringes are a special concern for these individuals 

Risk factors

Older age - Endocarditis occurs most often in older adults over age 60.

Artificial heart valves - Germs are more likely to attach to an artificial (prosthetic) heart valve than to a normal heart valve.

Damaged heart valves - Certain medical conditions, such as rheumatic fever or infection, can damage or scar heart valves, increasing the risk of infection.

Congenital heart defects

Implanted heart device - Bacteria can attach to an implanted device, such as a pacemaker, causing an infection of the heart's lining.

A history of endocarditis - Endocarditis can damage heart tissue and valves, increasing the risk of a future heart infection.

A history of illegal IV drug use

Poor dental health

Long-term catheter use - Having a catheter in place for a long period of time (indwelling catheter) increases your risk of endocarditis

Complications

Why they happen?

In endocarditis, clumps made of germs and cell pieces form an abnormal mass in the heart. These clumps, called vegetations, can break loose and travel to the brain, lungs, abdominal organs, kidneys, or arms and legs.

As a result, endocarditis can cause several complications, including:

Heart problems, such as heart murmur, heart valve damage and heart failure

Stroke

Pockets of collected pus (abscesses) that develop in the heart, brain, lungs and other organs

Blood clot in a lung artery (pulmonary embolism)

Kidney damage

Enlarged spleen

Investigations

Blood culture

Complete Blood count

Echocardiogram

ECG

Treatment

Medications

Surgery 

Heart valve surgery may be needed to treat persistent endocarditis infections or to replace a damaged valve

Doctor may recommend repairing the damaged valve or replacing it with an artificial valve