ENDOCARDITIS

Endocarditis, also called infective endocarditis (IE), is an inflammation of the inner lining of the heart.
The most common type, bacterial endocarditis, occurs when germs enter your heart. These germs
come through your bloodstream from another part of your body, often your mouth. Bacterial
endocarditis can damage your heart valves. If untreated, it can be life-threatening. It is rare in
healthy hearts.

Risk factors include having

 An abnormal or damaged heart valve
 An artificial heart valve
 Congenital heart defects
Symptoms of endocarditis
 The symptoms of acute bacterial endocarditis (ABE) occur within a few weeks of infection. The
symptoms of subacute bacterial endocarditis (SBE) may take weeks or months to develop. Some
of the general symptoms of endocarditis can include:
 Fever and chills
 Lethargy
 Loss of appetite
 Generalised aching throughout the body
 Abnormal heart rhythms such as a slow heart rate or tachycardia (rapid heart rate)
 Heart murmur
 Increased breathing
 Persistent cough.
Disease pattern of endocarditis
Usually, an infection somewhere else in the body causes bacteria to circulate in the blood (bacteraemia).
The bacteria that cause most cases of endocarditis belong to the Staphylococcus family, such
as Staphylococcus aureus and ‘golden staph’, a drug-resistant form of Staphylococcus aureus.

The bacteria infect the already damaged or diseased areas of the heart. Prosthetic devices (such as
artificial heart valves) may be susceptible to infection because the immune system does not recognise
these devices as part of the body and may not protect them as aggressively. The infection causes
inflammation and blood clots, while the body’s natural healing process causes scarring. A scarred
endocardium or heart valve is susceptible to future infections.
Complications of endocarditis
 Endocarditis can cause complications including:
 Reduced function of a heart valve
 Spread of infection to other areas of the heart
 Spread of infection to other areas of the body such as the brain
 Blocked blood vessels – a blood clot may break free from the endocardium, lodge inside a blood
vessel, reduce the blood flow to associated tissues or organs and lead to further complications .
Procedures that may cause endocarditis
 Short-term bacteraemia may be caused by certain dental and surgical procedures including:
 Professional tooth cleaning
 Any dental procedure that is likely to cause bleeding (such as tooth extraction)
 Intravenous lines used during or after surgery
 Investigation of the lungs with a telescopic device called a ‘rigid bronchoscope’
  Surgery to remove the tonsils (tonsillectomy)
 Surgery to remove the adenoids (adenoidectomy)
 Urinary tract surgery
 Gastrointestinal surgery
 Gall bladder surgery
 Prostate surgery
 Heart surgery.
DIAGNOSIS
Physical examination
 Your GP will check for the symptoms of endocarditis, such as fever or nodules (small lumps) on
your fingers and toes.
 They'll also listen to your heart using a stethoscope to see if you've developed a heart murmur.
A heart murmur is where your heartbeat has an extra, or unusual, sound caused by a disturbed
blood flow through the heart.
 The symptoms of endocarditis are similar to those of other conditions, so it's important that
other possible causes are ruled out. Sometimes, you may be referred for further tests.
Blood tests
 Blood tests may be used to help diagnose endocarditis, or to help identify the most effective
treatment. Blood tests may include:
 a blood culture test – to check for a specific bacteria or fungi
 an erythrocyte sedimentation rate (ESR) test
 a C reactive protein (CRP) test
 ESR and CRP tests can be used to check for inflammation. About 90% of endocarditis patients
have an elevated ESR or CRP.
 Read more about different types of blood test.
Echocardiogram
 An echocardiogram uses sound waves to scan your heart. The waves can produce accurate
images of the heart muscle, chambers and valves. This allows your doctor to examine the
structure and function of your heart more closely.
 An echocardiogram is often used to check for any clumps of bacteria that may have formed, and
can help detect infected or damaged heart tissue.
These scans can be performed by either: 
 directly placing a probe on your chest
 swallowing a probe to allow your heart to be studied from inside the gullet (transoesophageal
echo) 
 The transoesophageal echo allows much clearer images of your heart as the gullet is just behind
the heart.
 Computerised tomography (CT) scan
 A computerised tomography (CT) scan uses X-rays to take pictures of the inside of your body. A
computer is then used to piece the images together.
 A CT scan can be useful for identifying any abscesses (collections of pus) that may have
developed in your body.
TREATMENT FOR ENDOCARDITIS
Principles of Treatment
 The type and length of treatment depends on the following:

 Type of valve infected (artificial valve or your own natural valve)

  Type of organism infecting the valve (bacteria or fungi)
 Symptoms and severity of illness

Treatment options include:

 A four to eight-week course of antibiotics
 Surgery to repair severe damage to heart tissue
 Surgery to repair or replace severely damaged heart valves or destroyed cardiac devices such as
prosthetic heart valves
 Blood-thinning medication – medications such as aspirin or warfarin may be given to treat blood
clots
 antibiotics
 antifungal medicine
 Surgery

PREVENTION
 body piercings
 tattoos
 IV drug use
 any procedure that might allow germs to enter your blood
 Article resources