Inflammation of the connective tissue lining of the heart is usually the result of a bacterial infection. It often affects children and adolescents and can lead to severe heart valve damage. The endocardium (endo = inside and card = relating to the heart) are the connective tissue structures that partially line the interior of the heart and also form the heart valves. Due to the pumping actions of the heart muscle and the resulting blood flow, the freely moving parts of the endocardium also remain in constant motion, like the valves of an engine, and are thus subjected to strong mechanical stresses.
Endocarditis: life-threatening inflammation
Inflammatory processes in the endocardium, known as endocarditis, can lead to severe scarring, adhesions, and functional impairment of the heart valves – with far-reaching effects on the performance of the heart muscle and thus on circulatory function. Acute endocarditis is potentially life-threatening – and fatal in more than 15 percent of cases.
Causes and forms of endocarditis
In most cases, endocarditis develops either as a malfunctioning immune system reaction after a streptococcal infection (rheumatic endocarditis) or in inflammatory processes caused by microbes (infective endocarditis). The mitral valve, i.e. the valve between the atrium and ventricle in the left heart, is particularly frequently affected.
A distinction is made between two forms of endocarditis:
- Rheumatic endocarditis
- Infective endocarditis
Causes of rheumatic endocarditis.
Rheumatic endocarditis often affects not only the endocardium, but also the entire heart muscle (myocardium) and the outer lining of the heart (pericardium). The trigger is a preceding infection with a certain bacterial pathogen type. Due to a malfunction of the body’s own defenses, an excessive reaction of the immune system can subsequently occur, whereby not the pathogens causing the disease, but the body’s own tissue is attacked – in this case the endocardium, in particular the heart valves. This reaction belongs to the autoimmune diseases.
In rarer cases, other diseases can also trigger such non-infectious (abacterial) endocarditis. In these, inflammation of the connective tissue throughout the body can occur – and thus also inflammation of the connective tissue heart valves. These include, for example, chronic polyarthritis, ankylosing spondylitis, and lupus erythematosus.
Infective endocarditis: bacteria as a trigger.
In contrast, infectious endocarditis, the inflammation on the valve tissue is directly triggered by bacteria that colonize and multiply on site (bacterial endocarditis). In addition, fungi can also cause endocarditis.
Symptoms of endocarditis
Rheumatic endocarditis is more common in childhood or adolescence than in adulthood. Bacterial endocarditis can be very sudden (acute form) and then cause high fever, weakness and joint pain, sometimes skin lesions (small hemorrhages), and shortness of breath within a short time.
In the more common insidious (subacute) form, the focus is more on slowly developing nonspecific symptoms, such as
- Fatigue
- Fatigue
- Reduction in performance
- Slight increase in temperature
- Night sweats or
- Decrease in red blood pigment
It is not uncommon for this to cause the possibility of serious heart disease to be initially overlooked and only considered when (new) heart murmurs are heard on listening.
When the signs are not recognized
If prolonged, symptoms of heart failure may develop. If endocarditis is detected too late, inflammation may repeatedly develop at the pre-damaged heart valve and irreparably damage the heart valves (chronic course).
