Endocarditis
Introduction
The inside of your heart contains four chambers and four valves lined by a thin membrane called the endocardium. Endocarditis is an infection of this inner lining.
Endocarditis typically occurs when bacteria or other germs from another part of your body, such as your mouth, spread through your bloodstream and lodge in your heart. Left untreated, endocarditis can damage or destroy your heart valves. The consequences can be life-threatening.
Endocarditis is rare in people with healthy hearts. People at greatest risk of endocarditis have a damaged heart valve, an artificial heart valve or other heart defects.
If you're at risk of endocarditis, you may need antibiotics before certain medical or dental procedures. Also watch for signs and symptoms of infection. Prompt treatment can help you avoid this serious condition.
Signs and symptoms
Endocarditis may develop slowly or suddenly — depending on what's causing the infection and whether you have any underlying heart abnormalities.
Signs and symptoms may include:
- Fever
- Chills
- Weakness
- Fatigue
- Aching joints and muscles
- Night sweats
- Shortness of breath
- Paleness
- Persistent cough
- Swelling in your feet, legs or abdomen
- Unexplained weight loss
- Blood in your urine
- A new heart murmur
- Tenderness in your spleen — an infection-fighting abdominal organ on your left side, just below your rib cage
Sometimes endocarditis causes red, tender spots under the skin of the fingers. These are known as Osler's nodes. You may notice tiny purple or red spots known as petechiae (puh-TE-ke-e) on other areas of the skin. Similar spots may appear in the whites of your eyes or under your fingernails.
Causes
Endocarditis occurs when germs enter your bloodstream, travel to your heart and lodge on abnormal heart valves or damaged heart tissue. Bacteria are the cause of most cases, but fungi, viruses or other microorganisms also may be responsible.
Sometimes the culprit is one of many common bacteria that live in your mouth, upper respiratory tract or other parts of your body. In other cases, the offending organism may gain entry to your bloodstream through:
- Certain dental or medical procedures. Any dental procedure that causes bleeding may allow bacteria to enter your bloodstream. Bacteria may be a concern with procedures involving the respiratory, urinary or intestinal tract as well.
- An infection or other medical condition. Bacteria may spread from an infected area, such as a skin sore. Gum disease, a sexually transmitted disease or an intestinal disorder — such as inflammatory bowel disease — also may give bacteria the opportunity to enter your bloodstream.
- Catheters or needles. Bacteria can enter your body through a catheter — a thin tube that doctors sometimes use to inject or remove fluid from the body. Contaminated needles and syringes are a concern for people who use intravenous (IV) drugs.
- Common activities. Even everyday activities such as brushing your teeth or chewing food can allow bacteria to enter your bloodstream — especially if your teeth and gums are in poor condition.
Typically, your immune system destroys bacteria that make it into your bloodstream. Even if bacteria reach your heart, they may pass through without causing an infection.
Most people who develop endocarditis have a diseased or damaged heart valve — an ideal spot for bacteria to settle. This damaged tissue in the endocardium provides bacteria with the roughened surface they need to attach and multiply.
Treatment
If your doctor suspects that you have endocarditis, you may need high doses of intravenous antibiotics in the hospital. Blood tests may help identify the type of microorganism that's infecting your heart. This information will help your doctor choose the best antibiotic or combination of antibiotics to fight the infection.
You may need to take antibiotics for up to six weeks to clear up the infection. Once your fever and the worst of your signs and symptoms have passed, you may be able to leave the hospital and continue antibiotic therapy in an outpatient setting. You'll need to see your doctor regularly to make sure your treatment is working.
Report to your doctor any signs or symptoms that your infection is getting worse, such as:
- Fever
- Headaches
- Joint pain
- Blood in your urine
- Chills
Finally, see your doctor immediately if you experience shortness of breath or swelling in your legs, ankles or feet. These signs and symptoms may indicate heart failure.
If the infection damages your heart valves, you may have symptoms and complications for years after treatment. Sometimes surgery is needed to treat persistent infections or replace a damaged valve.
Prevention
Certain dental and medical procedures may allow bacteria to enter your bloodstream. Antibiotics can help destroy or control these harmful bacteria.
If you're at risk of endocarditis, you may need to take antibiotics before:
- Procedures that may cause bleeding in your mouth. Your doctor or dentist may prescribe an antibiotic to be taken by mouth one hour before any procedure that may cause bleeding in your mouth — including routine dental cleanings. In some cases, an injectable antibiotic may be prescribed.
- Procedures involving the respiratory, urinary or intestinal tract. You may need antibiotics before having your tonsils or adenoids removed or having certain types of throat exams. Antibiotics may be recommended before procedures affecting the bladder, prostate or urethra. Some gynecological procedures (not including routine pelvic exams or Pap tests) call for antibiotics as well. If your risk of endocarditis is high, your doctor may recommend taking injectable antibiotics just before the procedure and again six hours afterward. If your risk is lower, you may only need oral antibiotics before the procedure.
- Certain nonmedical procedures. It also may be wise to take antibiotics before procedures such as ear piercing and body tattooing. Check with your doctor ahead of time to find out the best way to protect yourself.
Informations obtained from National Institute of Health.