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Endocarditis – Causes, Symptoms and Treatment

Endocarditis is an inflammation of the inner lining of the heart, most often caused by bacteria. It frequently affects the heart valves and requires immediate medical treatment.

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Things worth knowing about "Endocarditis"

Endocarditis is an inflammation of the inner lining of the heart, most often caused by bacteria. It frequently affects the heart valves and requires immediate medical treatment.

What is Endocarditis?

Endocarditis is an inflammation of the endocardium – the inner lining of the heart, which also covers the heart valves. In most cases, the heart valves are primarily affected, which is why the condition is commonly referred to as infective endocarditis. Although relatively rare, endocarditis is a potentially life-threatening condition that requires prompt diagnosis and treatment.

Causes

Endocarditis is most commonly caused by bacteria that enter the bloodstream and attach to the heart valves or other parts of the endocardium. In rare cases, fungi or other microorganisms may be responsible. Common entry points for pathogens include:

Dental procedures and oral infections
Surgical or invasive medical procedures
Skin infections or open wounds
Intravenous drug use
Implanted devices such as pacemakers or prosthetic heart valves

The most frequently identified bacteria are Staphylococci and Streptococci. People with pre-existing heart valve damage, prosthetic valves, or congenital heart defects face a significantly higher risk.

Symptoms

The symptoms of endocarditis often develop gradually and may initially be non-specific. The most common signs and symptoms include:

Persistent fever and chills
Night sweats
Fatigue and general malaise
Joint and muscle pain
New or changed heart murmur
Unexplained weight loss
Small red streaks under the fingernails (splinter hemorrhages)
Painful red nodules on the fingers or toes (Osler nodes)

In severe cases, emboli can develop when infected blood clots break off and travel to vital organs such as the brain, kidneys, or spleen, causing serious complications.

Diagnosis

Diagnosing endocarditis involves a combination of clinical assessment and diagnostic tests:

Blood cultures: Detection of bacteria or other pathogens in the bloodstream – this is the most critical diagnostic tool.
Echocardiography: Ultrasound imaging of the heart to identify vegetations (infected deposits) on the heart valves.
Blood tests: Elevated CRP and white blood cell count indicate an active infection.
ECG and additional imaging may be used as supplementary tools.

The Duke Criteria are widely used in clinical practice to assess the likelihood of infective endocarditis based on major and minor diagnostic criteria.

Treatment

Antibiotic Therapy

The primary treatment for infective endocarditis is high-dose intravenous antibiotics, typically administered over a period of 4 to 6 weeks. The choice of antibiotic depends on the identified pathogen and its antibiotic sensitivity profile.

Surgical Treatment

Surgery may be required in certain situations, such as:

Severe damage or destruction of a heart valve
Failure to respond to antibiotic therapy
Large vegetations posing a high risk of embolism
Heart failure as a complication of endocarditis

Prevention

Individuals at high risk – such as those with prosthetic heart valves or certain congenital heart defects – may receive antibiotic prophylaxis before certain medical and dental procedures to reduce the risk of endocarditis. Maintaining good oral and general hygiene is also an important preventive measure.

Prognosis

Endocarditis is a serious condition with an in-hospital mortality rate of approximately 15 to 30 percent, depending on the causative organism, the valves involved, and the overall health of the patient. However, early diagnosis and consistent treatment significantly improve the chances of recovery.

References

Habib G. et al. – 2015 ESC Guidelines for the management of infective endocarditis. European Heart Journal, 2015.
Prendergast BD. – The changing face of infective endocarditis. Heart, 2006.
Baddour LM. et al. – Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications. Circulation, 2015.

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