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Endocarditis

Endocarditis Treatment in Delhi, India

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Overview

Endocarditis is a rare condition that appears in the heart lining, heart valves, and heart muscles. The condition is also known as Infective Endocarditis. It is usually caused by an infection like bacterial, fungal or other germs. Endocarditis occurs when these germs spread through the bloodstream from another part of the body and attach to the heart's inner lining, the endocardium. The condition can become severe if not treated on time and may destroy or damage heart valves, causing some severe complications. 

Heart condition is more common in men than women. People aged 60 years or above are more likely to get affected by endocarditis. Infective endocarditis is also common in people with abnormal heart valves, prosthetic heart valves or people with pacemaker lead. The symptoms can appear suddenly, or they may develop over time. However, the condition is treatable with medications, and in some cases, surgery may also be required. 

Types of Endocarditis

There are three different types of infective endocarditis:

  1. Acute Bacterial Endocarditis: This is usually caused by the Staphylococcus Aureus bacteria. Acute bacterial endocarditis begins suddenly and can cause heart valve damage. 
  2. Subacute Bacterial Endocarditis: This is caused by Streptococcal bacteria. The disease develops on the damaged valves and causes symptoms over time. These can become life-threatening. 
  3. Prosthetic Valvular Endocarditis: This form of the disease occurs in people that have gone through valve replacement or tissue valve replacement surgery. The cases of prosthetic valvular endocarditis are highest with artificial aortic valve replacement. 

Infective Endocarditis Symptoms

Symptoms of endocarditis may develop suddenly, or they develop slowly over time. In the early stages of endocarditis, the symptoms may be similar to other illnesses, which may go undiagnosed. Some common signs and symptoms of endocarditis include:

  • Joint and muscle pain 
  • Chest pain 
  • Fatigue
  • Night sweats
  • Shortness of breath
  • Fever
  • Headache
  • Small painful lumps or nodules on the fingers
  • Blood in urine
  • Weakness
  • Unexpected weight loss
  • Tenderness in the spleen
  • Swelling in legs, feet, or abdomen

Endocarditis Causes

Endocarditis is usually caused by an overgrowth of bacteria. Some kinds of bacteria typically live in and on the body. They are present in the mouth, the respiratory system, the digestive tract, and more. However, when some bacteria enter the bloodstream, they reach the heart and infect the endocardium. 

They can form clumps known as vegetation on the heart valves, affecting the heart's overall function. Sometimes the clot can break off and spread to other areas of the body, kidneys, lungs, brain, and more. Some of the common causes of the bacteria entering the bloodstream may include the following: 

  • Dental Problems: Infections of the teeth or gums increases the risk of endocarditis and make it easier for the bacteria to enter the bloodstream.  
  • Bacterial infection: If there is any bacterial infection in another part of the body, it can also spread to the bloodstream and may enter the heart. 
  • Certain Surgical Procedures: Some procedures, like colonoscopy, can allow bacteria to enter the body. 
  • Sexually Transmitted Infections: Certain STIs like chlamydia or gonorrhoea make it easier for the bacteria to enter the body and go to the heart. 
  • Illegal IV Drugs: Using contaminated needles for injecting illegal IV drugs like heroin or cocaine can cause bacteria to enter the bloodstream and infect the endocardium. 

Endocarditis Diagnosis

The doctor may suggest the following test to confirm whether the patient is suffering from endocarditis or not. These may include: 

Blood Culture Test: The test is done to check for any germs in the bloodstream. The blood culture test can help the doctor to choose medications accordingly. 
Transthoracic Echocardiogram: In this test, the healthcare provider uses a wand-like device, known as a transducer, that produces sound waves. The device is held on the chest to create video images of the heart in motion. 
Transesophageal Echocardiogram: The surgeon gets a detailed look at the heart valves in this test. The doctor inserts a small transducer attached to the tip of a flexible tube. The tube is then inserted into the mouth and goes down to the oesophagus. 
Electrocardiogram (ECG or EKG): The test is done to measure the duration and timing of the heartbeats. The test helps to understand what is affecting the heart's electrical activity. 
Chest X-ray: The test is done using X-rays to show the condition of the heart and lungs. It helps to determine whether endocarditis has caused the heart to swell or if there is an infection in the lungs.

Infective Endocarditis Treatment

Once endocarditis is diagnosed, it is essential to treat the condition on a priority basis to prevent it from damaging the heart valves or causing any serious complications. Depending on the type and severity of the condition, the doctor may suggest the following treatment:

Endocarditis Medications

If the endocarditis is caused due to bacteria, the doctor will prescribe intravenous antibiotic therapy. The doctor may give high doses of IV antibiotics to treat endocarditis, meaning that one needs to stay in the hospital for a week or more so that the doctor may determine whether the treatment is working or not. Once the symptoms are resolved, the doctor will prescribe antibiotics for several weeks to clear up the infection.

Endocarditis Surgery

The doctor may suggest going for heart valve surgery in some severe cases. During the surgical procedure, the surgeon may repair or correct the heart valves that were damaged due to endocarditis. The surgery may also be done to replace damaged valves, remove vegetation, drain fluid, dead tissues, or debris from infected tissues.

Risk factors of Endocarditis

The following factors may increase the risk of developing endocarditis, including: 

  • Older age
  • Damaged heart valves
  • Artificial heart valves
  • History of endocarditis 
  • Congenital heart defects
  • Implanted heart device 
  • Injecting illegal drugs using a contaminated needle
  • Tissue damage
  • Scarring of heart valves
  • Poor dental health

Prevention of Endocarditis

Endocarditis can be prevented by following good oral hygiene. This helps lower the risk of bacteria build-up in the mouth, which may enter the bloodstream. Understanding the signs and symptoms of endocarditis can also help with quick treatment.

If someone feels any symptoms related to this condition, they should immediately contact the doctor. Apart from this, one should avoid the following: 

  • Tattoos
  • Illegal IV drugs 
  • Body piercings 
  • A procedure that may allow germs to enter the blood

Complications of Endocarditis

Endocarditis causes bacteria or other germs clumps, which may break loose and reach other parts of the body. This may result in some severe complications, including:

  • Atrial fibrillation
  • Blood clots
  • Organ injury
  • Kidney inflammation
  • Stroke
  • Collection of pus that may develop in the brain, heart, or lungs 
  • Enlarged spleen
  • Heart failure

Outlook for Patients

Endocarditis is a serious condition that can be fatal if left untreated. However, with early treatments with high doses of antibiotics, the outlook for patients is generally favourable. One should take all possible steps to prevent the infection from spreading to other parts of the body. The doctors also suggest having regular dental check-ups and maintaining poor oral hygiene to reduce the risk of endocarditis.

Reviewed & Updated On

Reviewed by Dr. Balbir Singh, Chairman - Cardiac Sciences, Cardiology, Cardiac Electrophysiology-Pacemaker on 17-Jan-2023.


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