Endocarditis: Symptoms, causes, and treatment

Endocarditis is a rare condition that involves inflammation of the heart lining, heart muscles, and heart valves.

It is also known as infective endocarditis (IE), bacterial endocarditis (BE), infectious endocarditis, and fungal endocarditis.

An infection of the endocardium causes endocarditis. The infection is normally caused by streptococcal or staphylococcal bacteria. Rarely, it can be caused by fungi or other infectious micro-organisms.

It is twice as common in men as in women. In the United States, over 25 percent of cases affect people aged 60 years or above.

Studies suggest that endocarditis affects at least 4 in every 100,000 people each year, and that the number is increasing.

Treatment

The main course of treatment is antibiotics, but sometimes surgery is necessary.

Antibiotics

Most patients with endocarditis will receive antibiotics. These will be given intravenously, through a drip, so the patient will need to stay in the hospital. Regular blood tests will monitor the effectiveness of the medication.

Patients can usually go home when their temperature returns to normal and symptoms have subsided, but most will continue to take antibiotics at home.

The patient should keep in touch with their doctor to make sure the treatment is effective, and that side effects are not preventing recovery.

The most commonly used antibiotics are penicillin and gentamycin. Patients who are allergic to penicillin may be given vancomycin. Antibiotic treatment normally lasts from 2 to 6 weeks, depending on the severity of the infection, among other things.

Surgery

If the endocarditis has damaged the heart, surgery may be necessary.

[heart surgery]
Heart surgery may be necessary if there is damage to the heart valves.

Surgery is recommended if:

the heart valve is so damaged that it does not close tightly enough, and regurgitation occurs, where the blood flows back into the heart

the infection continues because the patient does not respond to antibiotic or antifungal medication

large clumps of bacteria and cells, or vegetations, are attached to a heart valve

Surgery may repair a heart defect or damaged heart valves, replace them with artificial ones, or drain the abscesses that have developed within the heart muscle.

[heart - endocarditis]
Endocarditis is an inflammation that affects the heart.

Endocarditis can happen when bacteria or fungi enter the body because of an infection, or when normally harmless bacteria that live in the mouth, upper respiratory tract, or other parts of the body attack the heart tissue.

Normally, the immune system can destroy these unwanted micro-organisms, but any damage to the heart valves can allow them to attach themselves to the heart and to multiply.

Clumps of bacteria and cells, or vegetation, form on the heart valves. These clumps make it harder for the heart to work properly.

They can cause abscesses on the valves and the heart muscle, damage tissue, and lead to abnormalities in electrical conduction.

Sometimes, a clump can break off and spread to other areas, such as the kidneys, lungs, and brain.

A dental problem or procedure that results in an infection can trigger it. Poor health in the teeth or gums increases the risk of endocarditis, as this makes it easier for the bacteria to get in. Good dental hygiene helps prevent heart infection.

Other surgical procedures can allow bacteria to enter, including tests to examine the digestive tract, for example, a colonoscopy. Procedures that affect the breathing tract, the urinary tract, including kidneys, bladder, and urethra, the skin, the bones and the muscles, are also risk factors.

A heart defect can increase the risk of developing endocarditis if bacteria enter the body. This can include a defect from birth, an abnormal heart valve or damaged heart tissue. People with an artificial heart valve have a higher risk.

A bacterial infection in another part of the body, for example, a skin sore or a gum disease, can lead to the spread of bacteria. Injecting drugs with unclean needles is a risk factor. Anyone who develops sepsis is at risk of endocarditis.

Sexually transmitted infections (STIs), such as chlamydia or gonorrhea make it easier for bacteria to enter the body and make their way to the heart.

A candida fungal infection can cause endocarditis.

Inflammatory bowel disease (IBD) or any intestinal disorders may also increase the risk, but the risk of a person with IBD developing endocarditis is still low.

Surgical or medical tools used in treatment, such as a urinary catheter or long-term intravenous medication can increase the risk.

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