Even if the inflammatory process at the heart valves cannot be seen directly by the physician, some tools exist to facilitate the diagnosis of endocarditis. Therefore, the medical history is important for the physician, especially preceding tonsillitis or joint inflammation and other complaints. During the physical examination, he pays particular attention to bleeding into the skin and mucosa, and when listening for heart murmurs.
Endocarditis: diagnosis by cardiac ultrasound.
Cardiac ultrasound can show more severe inflammation, buildup, and changes in the heart valves. An ECG shows whether the heart muscle is also affected by the inflammation (myocarditis). If endocarditis is suspected, blood cultures are taken several times to identify the underlying germ if possible. This is the best way to find an appropriate antibiotic or antifungal agent.
Complications and course
The most serious complication of acute bacterial endocarditis is life-threatening general infection of the whole organism (sepsis), which is repeatedly fanned by the inflammatory “smoldering fire” in the endocardium and can lead to death. In addition, individual particles of the inflammatory deposits can detach from the heart valves, enter the brain with the bloodstream, clog important vessels there and thus cause a stroke.
If the acute phase is survived, irreparable heart valve damage can develop – especially in the case of chronic recurrent endocarditis – which in the long term weakens the heart muscle, impairs cardiovascular function and can also damage the lungs.
An advanced defect in the mitral and aortic valves, which are most commonly affected by endocarditis, can eventually lead to heart failure; in addition, the risk of a certain cardiac arrhythmia, atrial fibrillation, is increased. This irregular, chaotic intrinsic rhythm of the atrium promotes the formation of blood clots, which in turn can travel to the brain and trigger strokes.
Long-term effects of endocarditis
The long-term effects of endocarditis depend largely on early diagnosis and effective treatment – especially since an endocarditically damaged heart valve is particularly susceptible to being repeatedly colonized by pathogens because of the increased mechanical stress.
If rheumatic endocarditis is treated in time, both acute damage to the heart valves and chronic secondary damage caused by recurrent inflammatory processes can be largely avoided. In the acute course of bacterial endocarditis, deaths must be expected in 30 to 40 percent, even in the age of modern medicine.
