Endocarditis – What is it, Causes, Symptoms and Treatments!

Endocarditis – What it is, Causes, Symptoms and Drug Treatments. Also, Endocarditis  is an infection of the inner lining of your heart  (endocardium). Endocarditis usually occurs when bacteria or other germs from another part of your body, such as your mouth, spread through your bloodstream and press into damaged areas in your  heart . Left untreated, endocarditis  can damage or destroy heart valves  and can lead to life-threatening complications. Treatments for Endocarditis  include antibiotics and, in certain cases, surgery. Endocarditis is uncommon  in people with healthy hearts.

People at higher risk for endocarditis  have damaged heart valves, artificial heart valves,  or other heart defects. Endocarditis  happens when bacteria or germs from another part of the body, such as those in the mouth, spread through the bloodstream and attach themselves to affected areas of the heart . Endocarditis is uncommon in people with a  healthy heart .

Causes of Endocarditis:  Endocarditis occurs  when germs enter the bloodstream, travel to the heart  , and attach themselves to abnormal heart valves or damaged heart tissue. Bacteria cause most cases, but fungi or other microorganisms can also be responsible. Sometimes the culprit is one of the many common bacteria that live in your mouth, throat, or other parts of your body. The offending organism can enter your bloodstream through:

• Daily oral activities. Activities like brushing your teeth or chewing food can allow bacteria to enter your bloodstream — especially if your teeth and gums aren’t healthy.
• An infection or other medical condition. Bacteria can spread from an infected area, such as a skin wound. Gum disease, a sexually transmitted infection, or a bowel disorder — such as inflammatory bowel disease — can also give bacteria the opportunity to enter the 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. The bacteria that can cause endocarditis  can also enter the bloodstream through needles used to tattoo or puncture the body. Contaminated needles and syringes are a particular concern for people who use intravenous (IV) drugs.
• Certain dental procedures. Some dental procedures that can cut your gums can allow bacteria to enter your bloodstream.
  Normally, your immune system destroys the bacteria that make it into your bloodstream. Even if the bacteria reach your heart, they can pass without causing an infection.

Most people who develop endocarditis  have a diseased or damaged heart valve – an ideal place for bacteria to colonize. This damaged tissue in the endocardium provides bacteria with the roughened surface they need to attach and multiply. Endocarditis occasionally occurs in previously normal heart valves . 

Symptoms of Endocarditis:  Endocarditis can  develop slowly or suddenly – depending on what is causing the infection and whether you have any underlying heart problems. The signs and symptoms of endocarditis vary, but can include:

• fever and chills
• A new or changed heart murmur – heart sounds made by blood rushing through your heart
• Fatigue
• Joint and muscle pain
• night sweat
• Shortness of breathe
• Pallor
• persistent cough
• Swelling in the feet, legs or abdomen
• unexplained weight loss
• Blood in your urine (visible or found in the doctor’s view of your urine under a microscope)
• Tenderness in your spleen – an infection-fighting abdominal organ on your left side, just below your rib cage
• Osler’s knots – red, tender patches under the skin of the fingers
• Small purple or red spots on your skin, whites of your eyes, or inside your mouth

When to See a Doctor:  If you develop signs or symptoms of Endocarditis , see your doctor right away – especially if you have risk factors for this serious infection, such as a heart defect or a previous case of Endocarditis . While less serious conditions can cause similar signs and symptoms, you won’t know until you’re evaluated.

Endocarditis Risk Factors:  If your heart is healthy, you are unlikely to develop Endocarditis . The germs that cause infection tend to adhere and multiply on implanted or surgically implanted heart valves. Those at greatest risk of endocarditis  are those who have:

• Artificial heart valves. Germs are more likely to attach themselves to an artificial heart valve (prosthetic) than to a normal heart valve.
• Congenital heart diseases. If you were born with certain types of heart defects, your heart may be more susceptible to infection.
• A history of endocarditis. An episode of endocarditis  damages heart tissue and valves, increasing the risk of future heart infection.
• Damaged heart valves. Certain medical conditions – such as rheumatic fever or infection – can damage or scar one or more of your heart valves , making you more prone to endocarditis .
• History of intravenous use of illegal drugs (IV). People who use illegal drugs by injecting them are at a higher risk of Endocarditis . Needles used to inject drugs can be contaminated with the bacteria that can cause endocarditis .

If you have a known heart defect or heart valve problem, ask your doctor about your risk of developing endocarditis . Even if your heart condition has repaired or caused no symptoms, you could be at risk.

Complications of Endocarditis:  Endocarditis can  cause several major complications:

• Stroke and organ damage. In endocarditis , clumps of bacteria and cell fragments (vegetation) form in your heart at the site of infection. These clumps can break off and travel to your brain, lungs, abdominal organs, kidneys, or extremities. This can cause a number of problems, including stroke or damage to other organs or tissues.
• Infections in other parts of your body. Endocarditis can cause you to develop pockets of pus (abscesses) collected in other parts of the body, including the brain, kidneys, spleen, or liver . An abscess can also develop in the heart muscle itself, causing an abnormal heartbeat. Severe abscesses may require surgery to treat them.
• Cardiac insufficiency. Without treatment, endocarditis  can damage your heart valves and permanently destroy the inner lining of your heart. This can make your heart work harder to pump blood, eventually causing heart failure — a chronic condition where your heart can’t pump enough blood to meet your body’s needs. If the infection progresses without treatment, it is usually fatal.

Tests and Diagnosis of Endocarditis:  Your doctor may suspect endocarditis  based on your medical history and physical signs and symptoms, such as fever. Using a stethoscope to listen to your heart, your doctor may hear a new heart murmur or a change in a previous heart murmur — possible signs of endocarditis . The infection can mimic other diseases in the early stages. Several tests may be needed to help make the diagnosis:

• Bloodtests. The most important test is a blood culture used to identify bacteria in the bloodstream. Blood tests can also help your doctor identify certain conditions, including anemia — a lack of healthy red blood cells that can be a sign of endocarditis .
• Transesophageal echocardiogram. An echocardiogram uses sound waves to produce images of your heart at work. This type of echocardiogram allows your doctor to take a closer look at your heart valves . It is often used to check for signs of infection. During this test, an ultrasound device is passed through the mouth and into the esophagus – the tube that connects the mouth and stomach.
• Electrocardiogram (ECG). Your doctor may order this non-invasive test if he or she thinks that endocarditis  may be causing an irregular heartbeat. During an ECG, sensors (electrodes) that can detect your heart’s electrical activity are attached to your chest and sometimes to your limbs. An ECG measures the time and duration of each electrical phase in your heartbeat.
• Chest X-ray. X-ray images help your doctor see the condition of your lungs and heart. Your doctor may use X-ray imaging to see if endocarditis  has caused your heart to enlarge or if the infection has spread to your lungs.
• Computed tomography (CT) or magnetic resonance imaging (MRI). You may need a CT scan or MRI scan of your brain, chest, or other parts of your body if your doctor thinks the infection has spread to these areas.

Endocarditis Treatments:  The first line of treatment for Endocarditis  is antibiotics. Sometimes, if your heart valve is damaged by your infection, surgery is necessary.

Antibiotics:  If you have endocarditis , you may need high doses of intravenous (IV) antibiotics in the hospital. Blood tests can help identify the type of microorganism that is infecting your heart. This information will help your doctor choose the best antibiotic or antibiotic combination to fight the infection.

Typically, you will need to take antibiotics for two to six weeks or longer to clear up the infection. Once your fever and the worst of your signs and symptoms have passed, you can leave the hospital and continue IV antibiotic therapy with visits to your doctor’s office or at home with home care. You will need to see your doctor regularly to make sure your treatment is working. Tell your doctor any signs or symptoms that your infection is getting worse, such as:

• Fever
• Goosebumps
• Headaches
• joint pain
• Shortness of breathe

Diarrhea, a rash, itchiness, or joint pain could indicate a reaction to an antibiotic — another reason to call your doctor. See your doctor right away if you experience shortness of breath or swelling in your legs, ankles, or feet. These signs and symptoms may indicate heart failure.

Surgery:  If the infection damages your heart valves , you may have symptoms and complications for years after treatment. Surgery is sometimes needed to treat persistent infections or to replace a damaged valve. Surgery is also sometimes needed to treat endocarditis  which is caused by a yeast infection. Depending on your condition, your doctor may recommend repairing the damaged valve or replacing it with an artificial valve made from animal tissue or artificial materials.

Medications for Endocarditis:  When endocarditis  is caused by bacteria, the most commonly used medications to treat the condition are:

• amoxicillin
• Bepeben
• Erythromycin

NOTE: Only a doctor can tell you which drug is most suitable for you, as well as the correct dosage and duration of treatment. Always follow your doctor’s instructions to the letter and never self-medicate. Do not stop using the drug without consulting a doctor first, and if you take it more than once or in much larger amounts than prescribed, follow the instructions on the package insert.

Prevention of Endocarditis:  To help prevent Endocarditis , be sure to practice good hygiene:

• Pay special attention to your oral health – brush and use your teeth and gums often and have regular dental checkups.
• Avoid procedures that can lead to skin infections, such as body piercings or tattoos.
• Seek prompt medical attention if you develop any type of skin infection or open cuts or wounds that do not heal properly.

Preventive Antibiotics:  Certain dental and medical procedures can allow bacteria to enter your bloodstream. Antibiotics taken before these procedures can help to destroy or control harmful bacteria that can lead to endocarditis .

Because people with the following heart conditions  are at risk for more serious outcomes from endocarditis , they may need to take preventative antibiotics before certain medical or dental procedures to prevent endocarditis :

• Artificial heart valve (prosthetics)
• Previous endocarditis infection
• Certain types of congenital heart defects
• Heart transplant complicated by heart valve problems

Antibiotics are recommended before the following procedures:

• Certain dental procedures (those that cut your gum tissue or part of your teeth)
• Procedures involving the respiratory tract, skin, or infected tissue that connects muscle to bone

Antibiotics are no longer recommended before all dental procedures or for procedures of the urinary or gastrointestinal system. If you’ve had to take preventative antibiotics in the past before your dental exams, you may be concerned about these changes.

In the past, you were likely to have been given antibiotics out of concern that common dental procedures would increase your risk of endocarditis . But as doctors learned more about preventing Endocarditis , they realized that Endocarditis  is much more likely to occur from exposure to random germs than from a standard dental exam or surgery.

That doesn’t mean it’s not important to take good care of your teeth through brushing and flossing. There is some concern that mouth infections from poor oral hygiene could increase the risk of germs entering the bloodstream. In addition to brushing and flossing, regular dental checkups are an important part of maintaining good oral health.