An informative guide on Endocarditis

What is Endocarditis?

The endocardium is the internal lining of the heart. Endocarditis is also termed as “infective endocarditis.” Endocarditis is defined as “inflammation in the inner lining of the heart”, which is known as endocardium. The inflammation majorly occurs due to bacterial infection. When the infection causes inflammation, this is termed as “infective endocarditis.” Endocarditis is not very common in individuals whose heart is healthy.

Approximately 29,000 individuals suffer from endocarditis every year, according to the American Heart Association (AHA),

In infective endocarditis also termed as bacterial endocarditis, occurs due to bacterial infection, which gets into the blood-stream and gets settled in the lining of the heart, heart valve or blood vessels. Infective Endocarditis is not very common, but individuals who are already suffering from heart issues/disease have higher chances of getting it.

Infective Endocarditis results in “growth (vegetation)” above the valves of the heart, makes toxins and enzymes that affect the tissue (i.e. death and stops working) resulting in the holes on the valves of the heart, also grows out of the heart and the blood vessels. Other complications include valve being leaked, blockages of the heart and presence of abscesses around the valve of the heart. If no treatment for endocarditis, it if life-threatening and dangerous.

Bacteria are present in several places such as mouth, skin, intestine, respiratory system and urinary tract system. These bacteria enter the bloodstream via several different ways such as brushing teeth, stool passing and results in endocarditis. Valves of the heart which are normal are not prone to infections whereas if the valve is diseased it results in flaws on the exterior/outside where bacteria is connected. Rather than normal valve, the valves which are replaced are more susceptible to infections. Bacteria gathers together to arrange as a colony very fast, “grow vegetation”, generates enzymes that harm the nearby tissues resulting in the entrance for the bacteria or micro-organisms.

Two types of Endocarditis:

Acute Infective Endocarditis: It occurs instantly and becomes critical or fatal in some days.

Sub-acute or chronic IE (Infective Endocarditis): This occurs gradually in some weeks or many months.

Other types of Endocarditis includes:

Infectious or Bacterial Endocarditis: This occurs as a result of bacterial or fungal infection, that goes into the bloodstream and resides in the lining of the heart, the valve of the heart or the blood vessels. This occurs very rarely, but individuals suffering from cardiac issues, have a higher chance of getting it.

Non-infectious (Non-Bacterial) Endocarditis: This could be a result of too many diseases that affect the valves of the heart, majorly the left-sided heart. Any kind of illness or disease could result in the development of endocarditis which is infectious.

Symptoms for Endocarditis

The symptoms are not so critical or acute, they get developed gradually in some time. For an initial period, the symptoms were very much the same as other diseases or illness. This results in several cases being not diagnosed. In the case of endocarditis, the symptoms are very much the same as that of flu or other infections like pneumonia. Few of the individuals also undergo acute symptoms that occur instantly. These symptoms occur as a result of inflammation or the related harm/danger it results in.

Common Symptoms of Endocarditis are:

• Murmuring of the heart: It is the atypical sound of the heart of the blood flow which is unstable “through the heart.”
• Skin gets pale
• Fever or chills
• Night sweats
• Pain in the muscles or joints
• Appetite has decreased or nausea
• There is a feeling of fullness in the upper part of the body
• Weight loss happens suddenly and not intentional
• The feet, legs or abdomen gets swollen
• Breathlessness and Cough

Not so major common symptoms of endocarditis:

• In the urine, blood is seen
• Loss of weight
• The spleen gets enlarged and when touched it is soft.

There could also be a difference in the skin which consists of:

• Red or purple marks/patched that are tender are seen beneath/under the skin of fingers or toes.
• When the small red or purple patches/marks from the blood cells that exude out of the cracked capillary vessels, that occurs on the white part of the eye, inside of the cheeks, “roof of the mouth” or chest area.
• There is a lot of variation from one individual to others related to the signs and symptoms of “infectious endocarditis.” The symptoms occur as a result of the factors related to infection, the health of the heart and the duration of the presence of the infection which could vary over some time.
• It is important to immediately consult the doctor if any of the above symptoms occur or there is a history of the problems of the heart, surgery of the heart or previous case of endocarditis. Important to show the physician if there is a continuous fever and the individual feels fatigued without any reason and all the time, without knowing the reason for the same.

Causes of Endocarditis

The major reason for endocarditis is the excess growth of bacteria. These bacteria usually/commonly reside on the interior and exterior of the individual’s body, which might enter the bloodstream by either eating or drinking. Bacteria could also come in through the “cuts in your skin or oral cavity.” The bacteria/germs are taken care/fought off by the immune system of the individual as they result in an issue/complication, this procedure would not be successful in some of the individuals.

In the condition of infective endocarditis, the micro-organism travels via the individual’s bloodstream and enters the heart, where they grow or increase and result in inflammation. Fungi or other micro-organisms result in endocarditis.

Apart from drinking and eating, there are various ways through which germs or micro-organisms could enter the body. These include:

• Family History/ Genetic issues
• While the teeth are being brushed.
• Oral Hygiene is poor or Gum disease.
• Gums are cut while a dental procedure is done.
• Sexually transmitted disease
• Needles that are contaminated with germs or micro-organisms.
• Germs or micro-organisms are transferred via a urinary catheter or intravenous catheter.
• When undergoing some process for teeth.
• Inflammatory Bowel Disease (IBD): There is inflammation of the digestive tract which is over some time due to a group of diseases.

Risk Factors of Endocarditis

These areas mentioned below:

• Replacement of “artificial heart valve.”
• Defect in the heart
• Damage of the tissues due to the presence of endocarditis in the past.
• Damage to the heart valve which results in scarring (marks), that results in the growth of bacteria and micro-organisms.
• Intravenous drugs are injected illegally or the ones which are prohibited with a needle that is contaminated with either bacteria or micro-organisms.

Diagnosis for Bacterial Endocarditis

The treatment for bacterial endocarditis is done depending on the symptoms present in the individuals, as an outcome of physical examination and tests done for diagnosis.

Certain symptoms that occur due to infection or fever, majorly above 100 Degree F (38.4 Degree C). Other signs and symptoms for infection includes having chills, rashes on the skin, redness, swelling, pain or tenderness of the skin, Non-healing wounds/cuts, Issues with the throat and problem in swallowing, pain or aches in the head, congestion of the nose, Cough i.e. dry or moist and stays for more than 2-3 days, in the mouth or tongues there are white patches, nausea, vomiting or diarrhea.

Blood Culture depicts micro-organisms or bacteria that are majorly found when endocarditis. Blood culture includes testing of the blood which is done over a period, which helps the laboratory identify the bacteria which is specific for causing infection. To secure the diagnosis, blood culture needs to be done before taking antibiotics.

Echocardiogram (Ultra-sound of the heart) depicts growth (on the valves there would be vegetation), “abscesses, and occurrence of “leaking or narrowing” or there is an away movement of the heart valve which is artificial from the tissue of the heart.

Transthoracic echocardiogram: This is an imaging technique used to have a look at the heart and the valves of the heart. This technique makes use of ultrasound waves that generates a picture of the heart. This “imaging test” is used by the physician to identify the signs of any harm to the heart or the irregular movement of the heart.

Transesophageal echocardiogram: When too much information is not provided by using a transthoracic echocardiogram, this technique of transthoracic echocardiogram is used. This is a sort of way used to have a look at the heart via the esophagus. To get a clear picture of the heart, the physician inserts the ultra-sound in the esophagus or the “food pipe.”

Electrocardiogram (ECG or EKG): This test is done to get a clear picture of the electrical activity of the heart. This test helps identify the abnormal heart rhythm or rate. There would be electrodes attached to the skin. These electrodes are connected to the electrical wires, which are in turn connected to the EKG Machine.

Chest X-Ray: If there is an issue with the lung or the lung collapses, it results in similar symptoms as that of endocarditis. By doing this X-Ray, it helps have a look at the lungs and check for the collapse of it or build-up of fluid in the lungs which is termed as pulmonary edema. The X-Ray helps identify the physician about difference in the endocarditis and other issues with the lungs.

Treatment of Endocarditis

Antibiotics: If bacteria is the cause of endocarditis, the treatment is done with IV (Intravenous Antibiotic) therapy. Till the infection and inflammation is not treated properly, the physician would advise to take antibiotics. Till there are no signs of improvement, these antibiotics would be constantly received by the patient for 1-week at-least. Even after discharge from the hospital, one might need to continue with antibiotic therapy. It could be then changed to oral antibiotics later on. At-least a period of six weeks is required for the antibiotic therapy to be completed.

Surgery: Surgery would be required if there is extended infective endocarditis or heart valves which are damaged due to endocarditis. To remove any tissue that is dead, scarred tissue, the build-up of fluid or “debris from the infected tissue”, surgery is required. If required to remove or repair the valve of the heart which is damaged, replacement to be done with “man-made material” or tissues of the animal, then surgery would be required.

Complications for endocarditis

Due to infection, there is an occurrence of damage to the heart. This consists of heart rhythm which is not normal like atrial fibrillation, clots of the blood, and injury to the organs and jaundice that occurs due to hyperbilirubinemia. If the blood is infected it could result in emboli, clots that go to different areas of the body.

Organs that could be damaged are:

• Kidneys: There could be inflammation of the kidney resulting in a condition termed as glomerulonephritis (this is inflammation of the kidney affecting their filters termed as glomeruli. Glomeruli help throw out fluids, electrolytes or waste in excess via the bloodstream and removes in the urine. This condition could occur suddenly or slowly).
• Lungs
• Brain
• Bones which majorly includes the spinal cord, which might get affected causing osteomyelitis (This cause inflammation of the bone resulting from the infection majorly the legs, arm or spine).

Prevention of Endocarditis

• To reduce the build-up of bacteria or any other micro-organisms in the mouth or going inside the bloodstream by maintaining oral hygiene and regular dental appointments. This decreases the harm of developing endocarditis via “oral infection” or injury.
• Do take the antibiotics as mentioned, if undergone any surgery.
• Important to keep a check on the signs and symptoms for endocarditis, when an individual is presented with a history of congenital heart condition, surgery of the heart or endocarditis.
• Do focus if there is constant fever or no known cause for fatigue. If any of the above-mentioned symptoms occur, do contact the physician.
• You should avoid body piercing, tattoos, IV drug use, and any technique that allows bacteria or micro-organisms that enter the blood.

References

1. https://www.ncbi.nlm.nih.gov/books/NBK470547/
2. https://www.nature.com/articles/nrdp201659
3. https://www.sciencedirect.com/science/article/abs/pii/S0891552009000427