Endocarditis – an infection in the heart

An infective endocarditis is a disease caused by inflammation of the endocardium —Membrane that lines the interior of the heart— by an infectious event, whether of bacterial or fungal origin. It is characterized by a colonization or invasion of the heart valves composed of platelets, fibrin, and colonies of pathogenic microorganisms.

According to the Spanish Journal of Cardiology, endocarditis is a very rare pathology, since it globally affects 3-4 patients per 100,000 inhabitants per year. In addition, its presentation is maximum in elderly people. If you want to know everything about endocarditis and its prognosis, keep reading.

What is infective endocarditis?

Endocarditis is an inflammation of the lining of the heart chambers and valves, usually caused by a bacterial infection.

The United States National Library of Medicine defines infective endocarditis (IE) as an inflammation of the lining of the heart chambers and valves. It is caused by a bacterial infection or, in rare cases, fungal in nature. Three main types can be distinguished:

  1. Acute bacterial endocarditis: when the clinical picture takes less than a month of evolution.
  2. Subacute: when the clinical picture has less than six months of evolution.
  3. Chronicle: symptoms have been evolving for more than six months.

According to the Intramed portal, the mortality rate of patients with IE is 15-20% with a mortality rate per year approaching 40%. The more the infection develops in the heart tissue, the lower the patient's chances of recovery.

It should also be noted that, although the event due to infection is known as endocarditis or IE, there are non-infectious types. Heart tissue dysfunction it can also be caused by the formation of fibrous blood clots not composed of microorganisms on the valves.

To know more: Are there bacteria in the heart?

What are your causes?

As indicated by the Spanish Heart Foundation, Heart infection occurs when certain germs enter the patient's bloodstream. From there, these pathogens travel with the blood to the heart and eventually settle in damaged heart tissue or physiologically abnormal valves.

In general, the leukocytes present in the immune system of a healthy person they kill these bacteria before they can settle on any tissue. Unfortunately in some specific conditions this is not the case. Among the most common causes of endocarditis we find the following events:

  • An infection or other medical condition: bacteria can enter the bloodstream through both internal and external injuries. For this reason, something as simple as an oral infection, under certain circumstances, could turn into endocarditis.
  • Catheters: a poorly sanitized catheter can contain bacteria in its materials, so these could enter when injected into the patient.
  • Medical, dental and surgical interventions: for example, bacteria can enter heart tissue directly during open heart surgery, although this is very rare.
  • Use of illegal drugs intravenously: a dirty syringe is a free route of entry for pathogens into the body.

It should be noted that abnormal heart valves or prosthetic hearts are more prone to infection than healthy tissue. Therefore, people who have undergone surgery of this nature or who have congenital defects in the organ are more likely to suffer from this pathology.

What are your symptoms?

Chest pain and fatigue are two of the symptoms of endocarditis.

The specialized portals mentioned above and the medical website MSDmanuals explain the typical symptoms of infective endocarditis. Among them are the following:

  • Fever and chills with a flu-like presentation.
  • A heart murmur; that is, an abnormal sound of the heart produced by turbulence due to acceleration of the blood.
  • Fatigue and pain in the joints and muscles.
  • Night sweats
  • Difficulty breathing and chest pain when doing so.
  • Swelling in the legs and abdomen.
  • Less frequent symptoms: unexplained weight loss, blood in the urine, spleen pain, and epidermal spots on different parts of the body.

Acute endocarditis presents with many of these symptoms clearly, while the subacute variant may remain for months with more succinct clinical signs before arterial obstruction or damage to any of the heart valves occurs.

Diagnosis and treatment of infective endocarditis

In general, the appearance of a heart murmur in the patient or the modification of an existing one are usually warning signs for the healthcare professional. Behind this, the potential patient will undergo blood cultures —To identify the pathogen—, blood tests and echocardiograms to observe the status of the heart valves.

An infective endocarditis must be treated immediately, Well, in many cases the patients who acquire it have been in hospital settings recently or have just undergone surgery, meaning that their health is even more fragile in this situation. Hospitalization and administration of intravenous antibiotics are required.

Once the time of greatest risk has passed, the Infectious Endocarditis Consensus published in the Revista Argentina de Cardiología shows that the following additional treatments are considered:

  • Antibiotic therapy from home for 4-6 weeks to kill all bacteria from heart tissue.
  • Heart surgery: This can be considered when the patient has suffered damage to the valves of the heart, there is data that indicates serious damage to an organ or strokes occur due to this infectious event.

Can it be prevented?

In a way, yes. It is recommended that people at high risk for infective endocarditis be given antibiotics before undergoing certain surgical, medical, and dental procedures. This includes patients with heart prostheses, congenital defects, or transplants.

On the other hand, the chances of a healthy person developing infective endocarditis are minimal. Still, seeing a doctor promptly when an infection is suspected – no matter how mild – is essential. Thus, any probability of spread to other systems is quickly prevented.

You may be interested: What is bacteremia?

Prevention is better than cure

As you have read in the previous lines, infective endocarditis is an isolated disease that occurs in few patients, but without treatment it is fatal in 100% of cases. For this reason, care must be taken when dealing with any infectious process.

If you have congenital heart disease, if you have had a transplant or if you have a prosthetic heart, you should be careful before undergoing any major surgical procedure. Talk to your trusted professional, Well, he will guide you throughout the process taking into account your condition.