Endocarditis: Symptoms, Causes, Treatment

What are the symptoms of endocarditis?

Endocarditis is an infection of the inner lining of the heart chambers and valves (endocardium). The symptoms of endocarditis can vary depending on the severity of the infection and whether it is acute (develops rapidly) or subacute (develops more slowly). Common symptoms of endocarditis may include:

Fever: A persistent fever is a common symptom of endocarditis. The fever may come and go or persist for an extended period.
Chills: Many people with endocarditis experience chills, which may accompany fever.
Fatigue: Fatigue or a general feeling of being unwell (malaise) is common in people with endocarditis.
Weakness: Endocarditis can cause weakness, especially with exertion.
Heart Murmur: Some people with endocarditis develop a new or changed heart murmur, which is an abnormal heart sound heard during a heartbeat.
Shortness of Breath: Endocarditis can lead to heart failure, which can cause shortness of breath, especially with physical activity or when lying flat.
Chest Pain: Chest pain may occur in some cases of endocarditis, especially if there is damage to the heart valves or if there are complications such as an abscess or embolism.
Palpitations: Some people with endocarditis may experience palpitations, which are sensations of a rapid, fluttering, or pounding heart.
Joint Pain: Joint pain, swelling, and stiffness (arthralgia) may occur in people with endocarditis, especially in subacute cases.
Nailbed Hemorrhages (Splinter Hemorrhages): Small lines of blood that run vertically under the nails may be present in some cases of endocarditis.
Petechiae: Small, red or purple spots on the skin, mucous membranes, or conjunctiva of the eyes may occur in some cases of endocarditis.
Osler’s Nodes: Painful, red or purple swellings on the fingers or toes may occur in some cases of endocarditis.
Janeway Lesions: Small, painless, red spots on the palms or soles may occur in some cases of endocarditis.

It’s important to note that the symptoms of endocarditis can be nonspecific and can vary widely among individuals. Some people with endocarditis may have few or no symptoms, especially in subacute cases. If endocarditis is suspected, prompt medical evaluation and treatment are essential to prevent serious complications.

What are the causes of endocarditis?

Endocarditis is typically caused by an infection of the inner lining of the heart chambers and valves (endocardium) by bacteria, fungi, or other microorganisms. The most common cause of endocarditis is bacteria, particularly strains of bacteria that are normally present in the mouth, skin, or gastrointestinal tract. The following are common causes and risk factors for endocarditis:

Bacterial Infections: Bacterial endocarditis is most commonly caused by bacteria entering the bloodstream and infecting the heart lining or valves. These bacteria can enter the bloodstream through activities that cause minor trauma to the mucous membranes, such as dental procedures, gum disease, or gastrointestinal procedures.
Dental Procedures: Dental procedures that cause bleeding, such as tooth extraction or deep cleaning, can allow bacteria from the mouth to enter the bloodstream and reach the heart.
Heart Conditions: Structural heart conditions, such as congenital heart defects, valve abnormalities, or previous episodes of endocarditis, can increase the risk of developing endocarditis.
Intravenous Drug Use: Intravenous drug use can introduce bacteria into the bloodstream, increasing the risk of endocarditis.
Health Conditions: Certain health conditions, such as diabetes, kidney disease, or HIV/AIDS, can weaken the immune system and increase the risk of infections, including endocarditis.
Artificial Heart Valves: People with artificial heart valves are at increased risk of developing endocarditis because bacteria can adhere to the artificial material.
Age: Endocarditis is more common in older adults, especially those over 60 years of age.
Gender: Men are more likely than women to develop endocarditis, although the reasons for this are not fully understood.
Poor Dental Hygiene: Poor dental hygiene can lead to gum disease, which increases the risk of bacteria entering the bloodstream during dental procedures.
IV Catheters: Central venous catheters used for intravenous (IV) therapy can increase the risk of endocarditis if bacteria enter the bloodstream through the catheter.

It’s important to note that while certain activities and conditions can increase the risk of endocarditis, the majority of people who are exposed to bacteria do not develop the infection. However, for individuals at higher risk, taking preventive measures, such as good dental hygiene and antibiotic prophylaxis before certain dental procedures, can help reduce the risk of developing endocarditis.

How is the diagnosis of endocarditis made?

The diagnosis of endocarditis is based on a combination of clinical evaluation, medical history, physical examination, and diagnostic tests. The following are common steps in the diagnostic process for endocarditis:

Medical History: Your healthcare provider will ask about your symptoms, medical history, and any risk factors for endocarditis, such as heart conditions or recent dental procedures.
Physical Examination: Your healthcare provider will perform a physical examination, including listening to your heart with a stethoscope to check for abnormal heart sounds (heart murmurs) that may suggest endocarditis.
Blood Tests: Blood tests are used to look for signs of infection, such as elevated white blood cell count and markers of inflammation (such as erythrocyte sedimentation rate and C-reactive protein). Blood cultures may also be done to identify the specific bacteria or fungus causing the infection.
Echocardiogram: An echocardiogram is a key imaging test used to diagnose endocarditis. This test uses sound waves to create images of the heart valves and chambers, allowing healthcare providers to look for signs of infection, such as vegetation (clumps of bacteria and debris) on the heart valves.
Other Imaging Tests: In some cases, other imaging tests, such as a chest X-ray or computed tomography (CT) scan, may be done to look for signs of complications of endocarditis, such as abscesses or emboli (clumps of infected material that can travel to other parts of the body).
Electrocardiogram (ECG): An ECG may be done to evaluate the electrical activity of the heart and look for any abnormalities that may suggest endocarditis or its complications.
Additional Tests: Depending on the specific situation, other tests may be done to evaluate the extent of the infection or look for complications. These may include transesophageal echocardiogram (a more detailed echocardiogram), magnetic resonance imaging (MRI), or positron emission tomography (PET) scans.

The diagnosis of endocarditis can be challenging, as the symptoms can be nonspecific and the condition can mimic other diseases. A multidisciplinary approach involving cardiologists, infectious disease specialists, and other healthcare providers is often needed to make an accurate diagnosis and develop an appropriate treatment plan. Early diagnosis and treatment are important for improving outcomes in individuals with endocarditis.

What is the treatment for endocarditis?

The treatment for endocarditis typically involves a combination of antibiotics and, in some cases, surgery to repair or replace damaged heart valves. The specific treatment approach depends on several factors, including the type of microorganism causing the infection, the extent of the infection, and the presence of any complications. Here is an overview of the treatment options for endocarditis:

Antibiotic Therapy: Antibiotics are the mainstay of treatment for endocarditis. The choice of antibiotics depends on the type of microorganism causing the infection and the sensitivity of the organism to antibiotics. In many cases, intravenous (IV) antibiotics are given initially, followed by oral antibiotics for a total treatment duration of 4 to 6 weeks or longer. The exact duration of antibiotic therapy depends on the individual case and should be determined by a healthcare provider.
Surgery: In some cases, surgery may be needed to repair or replace damaged heart valves or to remove infected tissue. Surgery may be recommended if the infection does not respond to antibiotics, if there is severe damage to the heart valves, or if there are complications such as heart failure, abscesses, or emboli (clumps of infected material that can travel to other parts of the body).
Supportive Care: Supportive care may be needed to manage symptoms and complications of endocarditis. This may include medications to manage pain, fever, or other symptoms, as well as close monitoring of heart function and overall health.
Prevention of Recurrence: After completing treatment, it’s important to take steps to prevent recurrence of endocarditis. This may include good dental hygiene, regular dental check-ups, and antibiotic prophylaxis before certain dental procedures for individuals at high risk of endocarditis.
Long-Term Follow-Up: Long-term follow-up with a healthcare provider is important to monitor for any recurrence of endocarditis or complications, such as heart failure or valve dysfunction.

The treatment of endocarditis is complex and requires a multidisciplinary approach involving cardiologists, infectious disease specialists, and other healthcare providers. The goal of treatment is to cure the infection, prevent complications, and restore optimal heart function. Early diagnosis and prompt treatment are essential for improving outcomes in individuals with endocarditis.

What is the mortality rate for endocarditis?

The mortality rate for endocarditis can vary depending on several factors, including the type of microorganism causing the infection, the extent of the infection, the presence of complications, and the overall health of the individual. In general, the mortality rate for endocarditis is estimated to be around 10% to 30%, but this can be higher in certain populations or in cases of severe infection or complications.

Factors that may increase the risk of mortality in endocarditis include:

Delayed diagnosis and treatment: Early diagnosis and prompt initiation of appropriate antibiotic therapy are crucial for improving outcomes in endocarditis. Delayed diagnosis or treatment can lead to the spread of infection and an increased risk of complications.
Age: Older age is a risk factor for mortality in endocarditis. Older adults may be more likely to have underlying health conditions that can complicate treatment.
Underlying health conditions: Individuals with underlying health conditions, such as heart disease, diabetes, kidney disease, or immunosuppression, may be at higher risk of mortality from endocarditis.
Complications: Complications of endocarditis, such as heart failure, valve dysfunction, emboli (clumps of infected material that can travel to other parts of the body), or abscesses, can increase the risk of mortality.
Type of microorganism: The type of microorganism causing the infection can also impact the mortality rate. Some microorganisms are more difficult to treat and may be associated with a higher risk of mortality.

It’s important to note that with advances in medical and surgical treatments, the mortality rate for endocarditis has improved in recent years. Early diagnosis, prompt initiation of appropriate antibiotic therapy, and close monitoring for complications are key to improving outcomes in individuals with endocarditis.