Endocarditis
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What is Endocarditis?
The endocardium is the lining of the heart and covers the flaps of its valves. When an area of endocardium becomes inflamed through infection, a fibrin clot called vegetation may form. In time this clot changes into a mass of scar tissue. The scarred endocardium becomes thickened, stiff and deformed.
How will this affect the heart valve?
Two disorders of the valve may result from these changes:
- Stenosis - In some instances the valve may not open fully and will obstruct the forward flow of blood. This is called 'valve stenosis'.
- Regurgitation - The valve may not close properly and results in a backflow of blood. This is called 'valve incompetence or regurgitation'. Sometimes the term 'leaky valve' is used to describe this problem.
What are the causes of endocarditis?
Bacterial endocarditis occurs when bacteria in the bloodstream (bacteraemia) lodge on abnormal heart valves or other damaged heart tissue.
Certain bacteria normally live on parts of your body such as the mouth and upper respiratory system, the intestinal and urinary tracts and the skin. Some surgical and dental procedures cause a brief bacteraemia. Although bacteraemia is common after many invasive procedures, only certain bacteria commonly cause endocarditis. What are the symptoms?
Sometimes it can be difficult to identify endocarditis as early symptoms are non-specific and include:
- Fatigue
- Weakness
- Fever
- Chills
- Night sweats (may be severe)
- Weight loss
- Muscle aches and pains
- Heart murmur
- Shortness of breath with activity
- Swelling of feet, legs, abdomen
- Blood in the urine
- Excessive sweating
- Red skin spots on the palms and soles (Janeway lesions)
- Paleness
- Nail abnormalities (splinter hemorrhages under the nails)
- Joint pain
- Abnormal urine color
- Red, painful intradermal nodes in the pads of the fingers and toes called Osler's nodes
What is the treatment for endocarditis?
Both medical and surgical treatment may be necessary especially if the valve has become severely infected.
Medical Treatment:
The treatment for endocarditis is usually intravenous (directly into the vein) antibiotic drugs for 4-6 weeks. This can either be via a small plastic tube (cannula) left in a vein, in the hand or arm (this may need to be replaced at least every 3 days), or it maybe via a longer line (central or Hickman line) sited in the upper chest wall or neck which feeds into a larger vein (this will be stitched in place and can be left for several weeks). The type and duration of the antibiotic treatment will be dependent on the type of germ causing the infection.
This will be determined from blood samples, which will need to be taken every few days to measure the amount of antibiotic in your system and the effectiveness of the treatment. Your doctor under advice from a specialist doctor (microbiologist), will decide the best course of treatment for your particular condition. As a result, although you may meet other patients with the same condition during your stay on the ward, their treatment may not be exactly the same as yours. You may be given a mixture of different types of antibiotics. These may be given 4 hourly (including overnight) or one or two times daily. Depending on the type of antibiotic it may be injected directly into the cannula or central line over a period of a few minutes or it maybe added to a small bag of fluid and allowed to drip into the tube over 30 minutes to an hour.
Surgical Treatment:
The infection of the valve can affect the flow of blood through the heart in two ways, valve stenosis and valve regurgitation.
If this happens surgical treatment will be necessary to help the valve work more efficiently. The valves can either be repaired or replaced. If the damage to the valve leaflets is severe the valve will be replaced rather than repaired. This may be with a mechanical valve or a tissue valve.
Can endocarditis be prevented?
Not all cases of endocarditis can be prevented because we don't always know when a bacteraemia occurs. However, when you're having some dental or surgical procedures, antibiotics are prescribed to prevent the bacteria from surviving in the bloodstream.
Prevention
Preventive antibiotics are often given to people with predisposing congenital or valvular abnormalities before dental procedures or surgeries involving the respiratory, urinary or intestinal tract. Continued medical follow-up is advised for people with a previous history of infective endocarditis.
Intravenous drug users are also at risk for this condition because unsterile injecting practices increase the exposure of the bloodstream to infectious agents. Treatment for addiction should be sought. If this is not possible, use of a new needle for each injection, avoiding sharing any injection-related paraphernalia and use of alcohol pads to sterilize the injection site can reduce risk.
