Endocarditis, or endocarditis, is a rare inflammatory disease of the heart‘s inner lining (endocardium) that is often associated with inflammation-related changes in the valve leaflets and can lead to damage to the heart valves. For this reason, it is also known as valvular heart disease. Whereas in the past endocarditis was often due to rheumatic fever, today endocarditis is increasingly due to bacterial causes.
What is endocarditis?
Endocarditis is an inflammatory disease of the inner lining of the heart (endocardium) that can lead to inflammatory changes in the valve leaflets and valvular defects. Depending on the underlying cause, a distinction is made between infectious or bacterial endocarditis and postinfectious abacterial or rheumatic endocarditis, each of which manifests itself with different symptoms. Thus, infectious (bacterial) endocarditis is accompanied by fever, feeling of weakness, weight loss, night sweats, anemia, and occasional heart and joint symptoms. In contrast, fever, polyarthritis (joint pain) of the larger joints with tenderness to touch, annular skin rashes, and subcutaneous nodules (Osler nodules), as well as a general feeling of weakness, are characteristic symptoms of rheumatoid endocarditis.
Causes
Bacterial endocarditis generally results from colonization of the heart valves by bacterial pathogens such as Staphylococcus aureus, streptococci, or enterococci. Pre-damaged heart valves are particularly at risk. In a healthy person, bacteria circulating in the bloodstream are usually rendered harmless by the body’s own immune defenses, while at the same time the endothelium (lining of the blood vessels) of the heart valves is resistant to these bacterial pathogens. If, on the other hand, the heart valves are damaged as a result of aortic valve stenosis, artificial heart valves, a previous endocarditis disease or congenital heart defects, the bacteria can settle on the heart valves and lead to the inflammatory reactions characteristic of endocarditis. In the presence of a weakened immune system or drug addiction, fungi can also cause endocarditis in addition to bacterial pathogens. Abacterial endocarditis, which is less common in this country, is etiologically due to a dysregulation of the body’s immune defenses as a result of postinfectious (after streptococcal infection) rheumatic fever. Antibodies formed against streptococci target endogenous structures such as the endocardium, damaging it and causing endocarditis.
Symptoms, complaints, and signs
The symptoms that occur with endocarditis depend on what form of progression it is. Thus, doctors distinguish between acute and subacute endocarditis. The extent of the disease also plays an important role. If it is an acute bacterial endocarditis, for which staphylococci are responsible in most cases, the symptoms appear suddenly and take a rapid course. Around 80 to 90 percent of all patients suffer from chills, fever and accelerated heartbeat (tachycardia). In 40 to 75 percent of all cases, night sweats and chills also occur. In approximately 25 to 50 percent of patients, there are feelings of discomfort, weight loss, anemia (anemia), arthralgias, and loss of appetite. In addition, there may be clouding of consciousness, hemorrhages, microembolism of the ocular retina, and headache and pain in the limbs. In addition, respiratory distress as well as skin lesions such as minor hemorrhages are within the realm of possibility. However, the subacute form, which takes a gradual course, is more common. Typical for this variant is the development of non-specific symptoms. These may include fatigue, exhaustion, a slight increase in body temperature and a reduction in performance. Furthermore, the red blood pigment decreases. If endocarditis persists over a longer period of time, there is a risk of heart failure. Furthermore, there is a risk of renewed inflammation forming at the pre-damaged heart valve, from which the heart valves are persistently damaged.
Diagnosis and course
Although the symptoms of endocarditis are usually nonspecific and similar to other febrile infectious diseases, in combination with valvular murmurs, they may be the first indication of the presence of the disease. The diagnosis is confirmed by the detection of the pathogens in serum by repeated blood cultures. In addition, an elevated erythrocyte sedimentation rate, leukocytosis (increased leukocyte count in the blood), and anemia and decrease in albumins can be detected. An echocardiography (ECG)(heart ultrasound examination), in particular the so-called transesophageal echocardiography via a tube through the esophagus, allows statements about changes in the heart valves. The course and prognosis of endocarditis depend to a large extent on the start of therapy. If diagnosed in time and therapy is started early, endocarditis has a good prognosis.
When should you see a doctor?
Because endocarditis can take a fatal course, a physician should be consulted as soon as a serious problem is suspected. This is manifested by unusual heart murmurs, fever or a general feeling of malaise. In case of tiredness, fatigue and persistent weakness, there are reasons for concern that need to be investigated and clarified. If pain occurs in the head, bones or joints, a visit to the doctor should be made. If the pain spreads or increases in intensity, a doctor is needed. Before taking any pain medication, consultation with a medical professional should be made to clarify side effects in advance. Disturbances in heart rhythm, an elevated pulse or palpitations are considered unusual. They should be investigated as soon as they persist for several days. If phenomena such as chills or sweating occur at normal temperatures, a physician should be consulted. Changes in the skin, sensitivity to touch, or temperature changes should be discussed with a physician. If redness or swelling of the skin is noticed, a physician should be notified. A drop in the usual level of performance, problems with concentration and persistent sleep disturbances can lead to further complications without medical treatment. It is therefore advisable to consult a doctor if the symptoms occur repeatedly over several weeks.
Treatment and therapy
In bacterial endocarditis, high-dose antibiotics are infused intravenously depending on the underlying pathogen, which has been determined in advance from blood cultures. The goal of antibiotic therapy is to eradicate (completely eliminate) the underlying pathogen, reduce the risk of septic embolism, and minimize damage to heart valves as well as adjacent structures. Intravenous antibiotic therapy lasts several weeks (four to six weeks) and should be continued orally thereafter if necessary. If pathogens continue to be detectable in the serum despite intravenous antibiotic therapy, if fever is persistent (ongoing), if heart failure is present, or if local spread of infection with abscess formation can be detected, cardiac surgery is required to repair or reconstruct the heart valves. In addition, in cases of severe acute aortic or mitral regurgitation combined with pulmonary edema or cardiogenic shock (rapid drop in the pumping capacity of the heart), surgery is performed immediately to repair or replace the affected valves. Postoperatively, intravenous antibiotic therapy is continued for at least two weeks. In cases of abacterial (rheumatic) endocarditis, penicillin (antibiotic) is usually used to eradicate the streptococcal infection and anti-inflammatory drugs such as acetylsalicylic acid or cortisone preparations are used to reduce the rheumatic symptoms. In cases of pronounced damage to the heart valve, surgical intervention (usually valve replacement) may also be required for rheumatic endocarditis.
Outlook and prognosis
Endocarditis is a potentially life-threatening disease. However, its course and prognosis depend on several factors. Without treatment, the disease often leads to death or severe heart failure, which is often fatal later. Acute endocarditis can lead to complications that require rapid intensive medical treatment.These complications include embolisms, spread of germs to other organs with abscess formation, sepsis (blood poisoning) and destruction of the heart valves. Embolisms can lead to strokes, pulmonary embolisms or kidney infarctions. Other organs are damaged by the spread of the germs. In severe cases, sepsis develops, which can lead to multiple organ failure. However, chronic forms of endocarditis are also very dangerous. In the long term, the development of severe heart failure is possible here, which could even make heart transplantation necessary later on. Even with intensive treatment of endocarditis, secondary damage can occur. Here, the prognosis depends, among other things, on the time of diagnosis and the start of treatment. Whether the endocarditis is infectious or noninfectious also plays a major role. Furthermore, previous diseases of the heart, the age of the patient and the state of the immune system have a major influence on the further course. Likewise, other preexisting conditions such as diabetes mellitus, among others, are also of great importance.
Prevention
Endocarditis prophylaxis is particularly indicated for people with pre-damaged heart valves. For this purpose, antibiotics (penicillin, clindamycin) are administered in advance of medical procedures through which bacteria can enter the blood (for example, dental procedures, tonsillectomy, pulmonary endoscopy) to prevent endocarditis.
Follow-up
With endocarditis, the individual has very limited options for follow-up care. First and foremost, this disease must be fully treated by a physician, as otherwise, in the worst case scenario, the affected person may die. The earlier the endocarditis is detected, the better the further course of this disease usually is. In most cases, this disease is treated with the help of medications, especially antibiotics. In this case, the patient must follow the doctor’s instructions and make sure to take them regularly. It should be noted that alcohol should not be drunk during this period, as it can reduce the effect. If the symptoms do not subside after a few days, a doctor must be consulted again in any case to prevent further damage to the heart valve. Even after successful treatment, regular examinations are useful to detect damage to the heart. During treatment, the patient should take it easy and rest as much as possible. The heart should not be put under unnecessary strain, so stressful activity should also be avoided.
This is what you can do yourself
Endocarditis is an inflammation affecting the heart, which is caused by bacterial colonization or fungal infection. It predominantly affects the inner lining of the heart as well as the heart valves. Patients with congenital heart and heart valve defects as well as heart diseases developed in the course of life are particularly at risk. However, anyone can be affected by endocarditis. The symptom can be prevented by various self-help measures. Affected persons should pay attention to thorough personal hygiene, especially in their daily work. Proper dental hygiene is also an important component, as numerous bacteria enter the bloodstream through the mouth. Self-care also includes a healthy balanced low-fat and vitamin-rich diet. To keep one’s immune system fit, it is necessary to give up bad habits such as smoking, excessive alcohol consumption, drugs and medication abuse. If the symptom breaks out, the immediate emergency medical service must be initiated if the patient feels unwell. Self-help should be limited solely to physical hygiene and prudent behavior in everyday life. Patients at risk and those affected can obtain a cardiac passport. Since endocarditis is treated with antibiotics, these can be taken as an emergency preparation for on the go and when an outbreak is suspected or before dental treatment. The medication will be noted in the cardiac passport.