Summary about Disease
Endocarditis is an infection of the inner lining of your heart chambers and heart valves (endocardium). It typically occurs when bacteria, fungi or other germs from another part of your body, such as your mouth, spread through your bloodstream and attach to damaged areas in your heart. Endocarditis can damage your heart valves, leading to complications.
Symptoms
Endocarditis symptoms can vary. They may develop slowly or suddenly. Common symptoms include:
Flu-like symptoms, such as fever, chills, and fatigue
New or changed heart murmur
Fatigue
Aching joints and muscles
Night sweats
Shortness of breath
Swelling in your feet, legs, or abdomen
Unexplained weight loss
Blood in urine
Tiny, painful, reddish or purplish spots under the skin of your fingers or toes (Osler's nodes)
Painless, flat, red spots on the palms of your hands and soles of your feet (Janeway lesions)
Small hemorrhages under the nails (splinter hemorrhages)
Causes
Endocarditis is primarily caused by:
Bacteria: Most common cause, often from bacteria entering the bloodstream during dental procedures, infections, or intravenous drug use. Staphylococcus and *Streptococcus* are frequent culprits.
Fungi: Less common, but more serious. Often occurs in individuals with weakened immune systems or those using intravenous drugs.
Other Germs: Less common. Risk factors that increase the likelihood of developing endocarditis include:
Damaged heart valves
Artificial heart valves
Congenital heart defects
A history of endocarditis
Intravenous drug use
Having an implanted medical device, such as a pacemaker or defibrillator
Medicine Used
Treatment for endocarditis involves high doses of intravenous (IV) antibiotics or antifungals. Specific medications are selected based on the type of infection (bacteria, fungi) and the specific organism causing the infection. Common antibiotics used include:
Vancomycin
Gentamicin
Ceftriaxone
Ampicillin
Penicillin Antifungal medications like Amphotericin B or azoles might be used for fungal endocarditis. Surgery may be required to repair or replace damaged heart valves, particularly if the infection is severe, or if antibiotic treatment is not effective.
Is Communicable
Endocarditis is generally not communicable (not contagious) from person to person. The bacteria or fungi that cause it usually come from within your own body or through direct introduction into the bloodstream (e.g., IV drug use). It is not spread through casual contact like coughing or sneezing.
Precautions
Good Dental Hygiene: Regular brushing, flossing, and dental checkups. Prophylactic antibiotics before dental procedures may be recommended for high-risk individuals.
Avoid IV Drug Use: Intravenous drug use significantly increases the risk of endocarditis.
Prompt Treatment of Infections: Treat any infections (skin, urinary tract, etc.) promptly to prevent bacteria from entering the bloodstream.
Inform Doctors: If you have a heart condition, inform your doctors and dentists about it, so they can take appropriate precautions.
Prophylactic Antibiotics: Follow your doctor's recommendations regarding prophylactic antibiotics before certain medical or dental procedures if you are at high risk.
Maintain a healthy lifestyle: A strong immune system can help protect against infections. Eat a balanced diet, exercise regularly, and get enough sleep.
How long does an outbreak last?
Endocarditis is not an outbreak-related disease in the traditional sense. It's an infection that develops in an individual. The "duration" of the infection, i.e., how long it lasts, depends on:
Severity of the infection: More severe cases will take longer to treat.
Type of organism: Fungal infections usually take longer to treat.
Response to treatment: Some people respond better to antibiotics than others.
Complications: If complications arise (e.g., valve damage), it will take longer to manage. Typically, antibiotic treatment lasts for 4-6 weeks. However, this can vary. If surgery is required, the overall treatment time will be longer, including recovery from surgery.
How is it diagnosed?
Diagnosis of endocarditis typically involves a combination of:
Medical History and Physical Examination: The doctor will ask about symptoms, medical history, and risk factors. They will listen to your heart for murmurs and look for other physical signs.
Blood Cultures: To identify the specific bacteria or fungi causing the infection. Multiple blood samples are usually taken.
Echocardiogram: An ultrasound of the heart. It helps visualize the heart valves and chambers to detect any abnormalities, such as vegetations (growths) or damage. There are two types:
Transthoracic echocardiogram (TTE): Non-invasive, performed on the chest.
Transesophageal echocardiogram (TEE): A probe is inserted down the esophagus for a clearer picture, especially for detecting smaller vegetations.
Electrocardiogram (ECG or EKG): To assess heart rhythm.
Chest X-ray: To evaluate the lungs and heart size.
Complete Blood Count (CBC) and other blood tests: These tests can help detect signs of infection and assess kidney function.
Modified Duke Criteria: A set of clinical criteria used to aid in the diagnosis of endocarditis. It considers major criteria (positive blood cultures, echocardiogram findings) and minor criteria (predisposing heart condition, fever, vascular phenomena, immunologic phenomena).
Timeline of Symptoms
The timeline of symptoms varies depending on the type of endocarditis:
Acute Endocarditis: Symptoms develop suddenly and progress rapidly over days to weeks. High fever, chills, and fatigue are common early symptoms.
Subacute Endocarditis: Symptoms develop gradually over weeks to months. Symptoms may be subtle and include fatigue, low-grade fever, night sweats, and weight loss. It's important to note that some people might experience very mild symptoms initially, while others have severe symptoms from the outset.
Important Considerations
Prompt Diagnosis and Treatment are Crucial: Untreated endocarditis can lead to serious complications, including heart failure, stroke, kidney damage, and even death.
Prophylactic Antibiotics: The recommendations for prophylactic antibiotics before dental or medical procedures have become more specific over time. It's important to discuss your individual risk factors with your doctor to determine if prophylaxis is necessary.
Long-Term Monitoring: Even after successful treatment, people who have had endocarditis may require long-term monitoring for complications, such as heart valve damage. Regular follow-up appointments with a cardiologist are important.
Importance of Patient Education: Individuals at risk for endocarditis should be educated about the signs and symptoms of the infection and when to seek medical attention.
Drug Resistance: With increasing antibiotic resistance, it's crucial to use antibiotics appropriately and to monitor for drug-resistant organisms in endocarditis cases.