Bacterial endocarditis is an inflammatory disease of the inner lining of the heart. It is caused by germs that enter the bloodstream and become lodged in the heart. The earliest possible administration of an antibiotic is crucial for successful treatment.
What is bacterial endocarditis?
Bacterial endocarditis is an inflammation of the inner lining of the heart caused by bacteria. The heart wall is made up of several layers of tissue, the innermost of which is the endocardium. It is a thin, smooth, and very fibrous skin that lines the inside of the heart and ventricles. The heart valves and tendons are also made of endocardium. Bacterial endocarditis can therefore also damage the heart valves and lead to valvular insufficiency (heart valve weakness). Bacterial endocarditis is divided into two groups depending on the pathogen. The acute form is caused by staphylococci and has a shorter course with pronounced symptoms. Subacute bacterial endocarditis is usually caused by streptococci and has a much slower and milder course. Bacterial endocarditis is more common in men than in women. Patients are usually older than 60 years.
Causes
Bacterial endocarditis is caused by pathogens that enter the bloodstream through foci of inflammation present in the body. Often, these inflammations are not even noticed by the affected person. Germs can also enter the body through medical procedures on blood vessels, such as a permanently placed access into a vein. The pathogens of subacute bacterial endocarditis, streptococci, are found on the skin or mucous membranes without having any harmful effect there. Only when they enter the blood system do they cause inflammation. This can happen, for example, during tooth extractions (pulling the tooth). These germs can also enter the bloodstream and thus the heart via inflammations in the gastrointestinal tract or in the urinary tract. Streptococci are less aggressive pathogens and cause only the mild, subacute variant of bacterial endocarditis. The acute form of the disease is usually caused by the far more aggressive staphylococci, but also by gonococci or pneumococci. They can enter the body via a central catheter or through the use of contaminated syringes. Bacterial endocarditis of the acute form can also occur after heart surgery.
Symptoms, complaints, and signs
Depending on how aggressive the pathogen is, various symptoms may occur with bacterial endocarditis. In less severe cases, there is fever and weakness. Affected individuals feel fatigued and tired, and occasionally cardiovascular symptoms occur. A typical symptom is chills, usually accompanied by night sweats. There is also loss of appetite, which rapidly leads to weight loss. In the acute form of bacterial endocarditis, these symptoms can rapidly increase in intensity as the disease progresses, causing severe vascular and organ damage. The heart is particularly affected – here the disease manifests itself, among other things, by the characteristic stabbing and occasionally also by cardiac arrhythmias. If it is scarlet fever, symptoms such as sore throat, nausea and vomiting as well as headache and pain in the limbs may occur. Somewhat later, the typical skin rash appears, which can be recognized by the pinhead-sized red spots. With a middle ear infection, there may be hearing difficulties, pain in the affected ear canal and fever. Sinusitis may be manifested by difficulty breathing and discharge. If bacterial endocarditis is corneal inflammation of the eyes, vision problems, purulent discharge, and other symptoms may occur.
Diagnosis and course
Subacute bacterial endocarditis progresses very slowly and insidiously. It begins with general signs of illness such as fatigue, low-grade fever, fatigue, and loss of appetite. As it progresses, night sweats and altered heart murmurs are added. Acute bacterial endocarditis shows similar symptoms, but they occur much more violently. The fever becomes so high that patients may suffer from clouding of consciousness. There is a risk of septic shock, which means complete collapse of the circulatory system and thus acute danger to life.Suspicion of bacterial endocarditis can be determined by a physical examination and by talking about the medical history with pre-existing heart defects or heart valve defects. In a blood test, inflammatory markers and the number of leukocytes provide information about an existing infection. Pathogen cultures are obtained to find out the causative agent of bacterial endocarditis.
Complications
Bacterial endocarditis can lead to multiform complications. Dangers come particularly from bacterial deposits on the heart valves, which can become dislodged and subsequently cause a blood clot. Smaller embolisms can lead to short-term failures, while large blood clots can result in a stroke. In addition, emboli can cause kidney, intestinal and spleen problems, depending on their size and location; as a result, there may be flank pain, blood in the urine, intestinal obstruction and cramps. If the arms and legs are affected, the poor circulation causes, among other things, pain attacks and sensory disturbances. In addition, emboli can lead to the formation of Osler nodules or petechiae; the painful skin conditions can trigger infections and leave permanent scars as they progress. Damage to the heart valves often results in cardiac insufficiency, from which various secondary diseases may develop, such as anemia or blood pressure disorders. Rarely, bacterial endocarditis also leads to jaundice or glomerulonephritis, a disease of the kidney and the immune system. The earlier the inflammation is detected, the more likely recovery is without serious health consequences.
When should you see a doctor?
If night sweats, aching limbs, or loss of appetite occur over a prolonged period, a visit to the doctor is advisable. These symptoms indicate subacute bacterial endocarditis, which is best treated promptly. At the latest, if accompanying chills and a gradual increase in body temperature are repeatedly noticed, a subacute inflammation of the inner lining of the heart must be assumed. The acute form, which manifests itself among other things by palpitations and shortness of breath, must be treated immediately. Other warning signs are clouding of consciousness, fatigue and a general decline in well-being. Externally, acute bacterial endocarditis is manifested by small skin nodules, roundish hemorrhages on the retina, and pinhead-sized skin hemorrhages. If these symptoms are noticed, a physician must be called immediately. Should emboli or organ failure develop, emergency medical services must be alerted. It may be necessary to provide initial care to the affected person until the emergency physician arrives. Since a prolonged hospital stay is likely, the affected person’s relatives should also be informed at the earliest possible time.
Treatment and therapy
Treatment of bacterial endocarditis is primarily by administration of antibiotics. It is important to start antibiotic therapy as soon as possible. The physician learns which type of antibiotic must be administered from the pathogen cultures, because the various antibiotic drugs are only ever effective against specific pathogens. In most cases, the antibiotics must be administered in high doses and over a longer period of time. As a rule, this is done on an inpatient basis via an infusion. Furthermore, the blood is liquefied by so-called anticoagulation (reduction of clotting ability). As a result, the blood becomes thinner and flows better, and any blood clots that may exist on the heart valves, in which the germs settle, gradually dissolve. Treatment of bacterial endocarditis must be continued until no more pathogens can be detected in the blood. In very severe cases, a heart valve may be so damaged by bacterial endocarditis that it must be replaced with an artificial valve in surgery. There may also be a need to surgically remove heart tissue that has been altered by the inflammation.
Outlook and prognosis
The prognosis of bacterial endocarditis depends on numerous different influencing factors. First and foremost, the origin of the bacterium is of particular importance in this disease. The prospect of cure must be considered critical if the pathogen does not respond to the administration of commercially available antibiotics.The chances of recovery increase with a pathogen that can be combated quickly and successfully with the available medical options. In addition, the stability of the patient’s immune system is decisive for a good prognosis. The healthier and younger the patient, the better the chances of recovery. This does not include children. Existing damage and diseases of the heart or the presence of another disease that weakens the organism have an unfavorable influence. Chronic diseases are considered unfavorable and significantly reduce the chances of success. Furthermore, finding the cause of endocarditis is elementary in the healing process. If the causes of endocarditis can be found and treated quickly, the prognosis improves. The time of diagnosis and thus the start of treatment are also important factors to consider. If treatment is started late, there is hypersensitivity to antibiotics and a resistant germ, bacterial endocarditis can have a fatal course. This is independent of the patient’s age and immune system.
Prevention
If one has already had heart surgery or suffers from heart disease and is about to have dental surgery or another medical procedure, one can prevent bacterial endocarditis by taking an appropriate antibiotic. In addition, as with the prevention of myocarditis, if you have a cold, flu or other illness, you should not exercise, as this can have a serious effect on your heart health. (See also: sudden cardiac death).
Follow-up
Follow-up care after treated bacterial endocarditis is lengthy and depends on the patient’s recovery. Thus, each person has different risks for recurrence of infection or for suffering a recurrence of bacterial endocarditis. After drug therapy, the heart is examined at regular intervals to check the tissue. In this way, any recurrence of infection can be quickly detected and timely treatment can be initiated. The checks are carried out at short intervals during and after treatment; after some time they become less frequent. Resting ECG, echocardiography and blood tests are usually used for this purpose. In children who have survived bacterial endocarditis, the risk of recurrence is considered increased. Therefore, these follow-up examinations usually must be performed throughout life. In patients who are considered to be conspicuous and who have a fever after treatment, the taking of a blood culture is considered to be particularly relevant. This quickly shows whether the pathogen causing the endocarditis may still be present in the body. Good dental health is considered a prophylactic measure because many pathogens of endocarditis enter the body through the oral cavity. Therefore, excellent dental health should be strived for by the patient throughout his or her life.
Here’s what you can do yourself
Individuals who have been diagnosed with bacterial endocarditis will require medical treatment in the first instance. The physician will tell the patient what, if any, self-help measures can be taken. Since it is a serious disease of the heart, all sports activities must be avoided. During antibiotic therapy, the patient must take it easy. The actual symptoms can be alleviated by the known measures. The characteristic fever can be alleviated by bed warmth and an adapted diet, while pain is treated by means of gentle analgesics. Medical drugs are not always prescribed here. Light preparations from nature, such as valerian or arnica, often already help. In the case of pronounced damage, however, comprehensive drug therapy is always necessary. In addition, an operation must be performed. After an operation on the heart, the patient must take it easy and watch out for any accompanying symptoms. A heart valve replacement carries the risk of various complications, which is why close consultation with the responsible physician is always indicated. Further self-help measures depend on the severity of the symptoms and whether further complications arise in the course of recovery. In general, bacterial endocarditis that is detected early and treated by a doctor will resolve reliably and quickly even without self-help measures.
