Endocarditis

What is Endocarditis?

Endocarditis is an infection of the inner lining of the heart (endocardium) or the heart valves. The infection may damage or even destroy the heart valves.

How does it occur?

Endocarditis occurs when bacteria in the bloodstream (bacteraemia) settle and grow on abnormal heart valves or other damaged heart tissue. Certain bacteria normally live on parts of the body, such as the mouth and upper respiratory system, the intestinal and urinary tracts, and the skin. Some surgical and dental procedures cause a brief bacteraemia. Although bactaeremia is common only certain bacteria like Streptococci commonly cause endocarditis.

Who is at risk?

Endocarditis rarely occurs in people with normal hearts. However, if they have certain preexisting heart conditions, they are at risk for developing endocarditis when a bacteremia occurs. Some of these conditions include having:

• an artificial (prosthetic) heart valve
  
• a history of previous endocarditis
  
• heart valves damaged by conditions such as rheumatic fever
  
• congenital heart or heart valve defects

What are the symptoms?

Endocarditis can cause a wide variety of symptoms, particularly in the earlier stages of infection. Patients may experience such general symptoms as fever, chills, fatigue, weight loss, muscle aches, and sweating. With such nonspecific symptoms it may be difficult for the doctor to recognize endocarditis.

As the infection progresses, other symptoms may develop. If the infection begins to damage the heart valve, the valve may become “leaky.” A leaky heart valve can eventually lead to blood backing up into the lungs. This accumulation of fluid in the lungs can cause shortness of breath. If the infection spreads to the kidneys, patients may notice blood in the urine. If the infection spreads to the brain, it can cause headaches, confusion, or even stroke.

How is it diagnosed?

Endocarditis is diagnosed when a thrombus or infection is noted on the valve. This is most easily done using an Echocardiogram(an ultraousn dof the heart) or Trans Esophageal Echocardiogram(TEE, a specialized echocardiogram). In some cases a cardiac MRI may also be required. A variety of tests are also performed to aid in treatment and management like blood culture, a complete blood count (CBC), Kidney function tests(KFT) etc. Some cases are "culture-negative", meaning no fungus or bacterium can be found.

What is the treatment?

Endocarditis is known to cause severe morbidity (a diseased state) and even death in patients. Antibiotics are recommended for the treatment of endocarditis. The commonly used antibiotics include amoxycillin, ampicillin, clindamycin, azithromycin,and cefazolin. However, once the culture reports are available, antibiotics are tailored to the infection. In most cases, these antibiotics are continued for a few weeks.  Endocarditis can be a very serious condition and these patients need to be hospitalised for optimal treatment. If not treated in time, it can result in heart failure and death.

Can endocarditis be prevented?

Not all cases of endocarditis can be prevented, because we don't always know when a bacteraemia occurs. However, when patients undergo dental or surgical procedures, antibiotics are prescribed to prevent the bacteria from surviving in the bloodstream. It is also important to maintain good oral health by regular visits to the dentist.