Introduction
Endocarditis is an inflammatory process at the endocardium, the inner layer that lines the heart. It can be caused by immune reactions caused, for example, by bacteria or viruses, as well as by a deposition of immune complexes or antibody reactions. The inflammation can be classified according to its location and appearance.
In most cases the heart valves are affected, in rare cases the heart chambers and vessels. In the case of a bacterial infection, a mostly greenish change in the valves is visible. Endocarditis begins with a change in blood flow and composition that allows the colonization of the endocardium on a previously damaged surface.
The consequence of these inflammatory processes can be the spread of the inflammation to muscles, heart valves and the entire inner skin of the heart. Depending on the severity of the endocarditis, heart failure and unspecific signs of infection may occur. Heart failure can be caused by a failure of the heart valves or by a reduced blood flow, which can lead to the death of heart muscle cells. In heart failure, the heart is no longer able to pump the resulting blood volume into the body’s circulation within a certain time.
Symptoms
Signs of increasing heart failure are heart murmurs and increased heart rate. Heart murmurs are sounds detected when listening with a stethoscope that do not correspond to normal heart sounds, which are caused by the opening or closing of the heart valves. The heart murmurs are caused by damage to the heart valves, which results in them not opening or closing properly.
This creates turbulence in the blood, which the treating physician can perceive with his stethoscope. The increased heart rate can more easily lead to cardiac arrhythmia. The general signs of inflammation in endocarditis include fever and chills.
Fever is an increase in body temperature that deviates from the target value set by the brain. It is the body’s attempt to fight the inflammation by improving its immune response to the infection and killing the pathogens. The shivering is a tremor of the muscles that promotes the increase in body temperature.
Once the immune system is activated and the pathogen is fought off, the fever returns to normal. The body temperature is now lowered by increased sweating. Another symptom is night sweat.
Night sweat is defined as a production of sweat during the night that deviates from the norm and can be of varying intensity depending on the cause. In the worst case, the patient has to get up several times during the night to wash his soaked bedclothes. Acute or chronic infectious diseases, tumors, hormonal disturbances of the metabolism, psychological diseases, neurological diseases, nutrition, medication and autoimmune diseases can be reasons for increased night sweat.
It is especially important to recognize the composition of fever, night sweat and weight loss. It is called B-symptomatics and can indicate a tumor. Night sweat can also cause a feeling of cold, which is another symptom of endocarditis.
The sensation of cold arises because the body regulates its temperature through sweating and can thus lower it. It is therefore usually a consequence of sweating. Weight loss can also be a symptom of endocarditis.
This is then unintentional and occurs without the patient changing his or her eating habits or due to a reduced appetite in the patient. Weight loss can generally be categorized according to whether it is desired or unwanted, duration, amount of body weight lost and loss of appetite. In addition to infectious diseases, which include endocarditis caused by the penetration of external pathogens into the bloodstream, there are other causes of unwanted weight loss.
Loss of appetite is caused by a disorder in the brain system responsible for hunger, the feeling of satiety and the desire to eat. This system is controlled by hormones and other messenger substances. It must be distinguished from the purely physical need for food intake in the case of an undersupply, which the body signals by a growling stomach, among other things.
- Intestinal infections and chronic intestinal diseases such as Crohn’s disease
- Gastric mucosa inflammations
- Pancreatitis
- Ulcers
- Worm infestation
- Food intolerances like gluten or lactose intolerance
- Diseases of liver, kidneys and bile ducts
- Metabolic disorders such as thyroid dysfunction
- Diabetes type 1
- Cancer diseases
- Mental illnesses like depression
- Eating disorders like anorexia or bulimia
- And the taking of medicines and drugs
The inflammatory reaction that develops during endocarditis can lead to infectious anaemia, which is an anaemia caused by this infection.
Infectious anaemia can also be caused by autoimmune diseases or tumours. Anaemia is accompanied by iron deficiency and can be determined by the fact that on microscopic examination of a blood smear, the red blood cells show a reduced red coloration and a reduced volume. In addition, the inflammation parameters CRP and the blood sedimentation rate are increased (see blood test).
During or after endocarditis, pain in the joints and joint inflammation may occur. As a result, the joint usually swells up and is restricted in its movement. This accompanying symptom particularly often affects the hip, knee or ankle joints.
Fatigue, exhaustion and poor performance are also signs of infection in endocarditis. The most dangerous complications are blood clots deposited under the heart valves or accumulated inflammatory cells, which are loosened and detached by the blood stream and enter the vascular system via the ventricles. From there, they can get stuck in all subsequent vessels and block them.
This is called an embolus, which triggers a vascular embolism. The area of the organ supplied by the vessel is no longer supplied with sufficient blood and the lack of nutrients and oxygen can lead to the death of cells. This can occur in all organs, especially the lungs and brain.
The kidney can also be affected by an embolism or lead to increased excretion of blood and proteins through the urine due to centres of inflammation in the kidney tissue. In the worst case of endocarditis, the inflammation spreads further from the lining of the heart, so that the pathogens can be carried over into the brain. This is known as herd encephalitis, which can cause clouding of consciousness.
In addition, infarctions of the retina of the eye and paralysis of facial areas due to cranial nerve deficits are possible. Depending on the trigger and symptoms of the endocarditis, the attending physician must decide whether therapy with immunosuppressants, antibiotics or antifungals is appropriate. Antimycotics are effective against fungi. The trigger for endocarditis could also be bacteremia.
