Endocarditis is an infection of the heart valves or endocardium. Occurs most frequently in patients who already have preexisting valvular disease or artificial valve.
Endocarditis is caused by bacteria (sometimes fungi) that enter the bloodstream and colonize inside the heart, usually heart valves. The bacteria enter the bloodstream in several ways, including dental interventions or surgical procedures. Brushing teeth or cleaning the teeth causes bacteria entering into bloodstream, if the patient doesn’t takes care of his teeth.
If the heart is normal, there is a lower risk of developing endocarditis. However, if there is a heart problem that causes abnormal blood flow, it increases the likelihood that bacteria or fungi to attach to heart tissue, thus greatly increasing the risk of endocarditis.
Some clinical conditions are at high risk: heart defects, heart valve defects, hypertrophic cardiomyopathy and artificial heart valves.
Other risk factors include:
– history of endocarditis;
– Hemodialysis, which is a mechanical purification of blood;
– Injection of drugs: risk is given by dirty or infected needles;
– AIDS (acquired immunodeficiency syndrome) – less able to fight infection.
Most patients with endocarditis have symptoms two weeks after infection. The first symptoms appear like non-specific, flu-like, fatigue (tiredness) or low fever. Infections with an aggressive bacterial strain produce symptoms more severe (such as high fever) and appear more rapidly, within a few days. If symptoms persist, especially on the background of a clinical condition with increased risk for endocarditis, you should consult a doctor.
– Fever and chills;
– Weight loss;
– Night sweats;
– Joint pain;
– Persistent cough and dyspnea (difficulty breathing);
– Bleeding under the nails;
– Petechiae (small purplish or red spots under the skin).
The doctor can communicate to patient if it has an increased risk of endocarditis before making any investigations or medical, surgical or dental intervention. The doctor may give the patient a card written as it needs antibiotic prophylaxis prior to undergo various medical procedures. Symptoms of heart failure may occur if the heart valve is affected severely.
The first step in the diagnosis of endocarditis is anamnesis (medical history) and a clinical examination. It may require many more tests to diagnose endocarditis. These include:
– Blood cultures: are recommended three blood cultures to identify bacteria or fungi in the bloodstream; However, three blood cultures sometimes fail to detect germs that caused endocarditis and require other tests
– Echocardiography including transthoracic echocardiogram and the trans-oesophageal echocardiogram; can detect infected areas, heart valve defects and other defects;
– Electrocardiogram (ECG): An ECG may reveal if the rhythm is regular (endocarditis can cause abnormal rhythm).
It may need more tests to identify complications of endocarditis. These tests include:
– Chest radiography, which can show whether the heart is enlarged or if there are signs of heart failure;
– Urinalysis, which can show if there is blood and protein in urine;
– Computed tomography or MRI: These tests can show if the blood clot caused by endocarditis caused the appearance of a stroke and can be useful in deciding treatment;
– Cardiac catheterization: being used before valve replacement surgery to determine the risk of coronary heart disease.
There are three main goals when treating endocarditis: rapid destruction of infection, valve repair or replacement (if needed) and treatment of complications.
Patient suffering from endocarditis requires several weeks of treatment with one or more antibiotics. Initially, the treatment will be performed in the hospital for intravenous antibiotics (infusion) and other tests may be necessary during treatment. When the fever disappeared and the patient is stable intravenous antibiotic treatment can be continued at home with the help of a nurse.
Antibiotics are usually given for 4-8 weeks, but some patients require only 2-4 weeks. Antibiotics need to be administered in large enough quantities and over a period of time long enough to kill bacteria. After the initial dose of intravenous antibiotics, the doctor may recommend oral antibiotics.
It is important to follow the treatment rigorously to the last dose of antibiotic. If symptoms return, you must call your doctor immediately. Probably you will need additional doses of antibiotic if tests show that the bacteria were not removed completely.
If endocarditis is caused by a fungus, you will need an antifungal intravenously. However, usually, patients with fungal endocarditis need heart valve replacement surgery.
If heart valves are severely affected due to endocarditis or if an infection develops on the surface of the artificial valve, you may need surgery to repair or replace the valve.
Treatment of Complications
If complications arise due to endocarditis, such as heart failure or stroke, you may need additional treatment for them.
Treatment for endocarditis is generally guided by a specialist in infectious diseases. A cardiologist may also be involved in treatment management if the heart muscle or heart valves are affected. It requires a surgeon to perform cardiovasular valve replacement surgery.
Outpatient treatment (at home)
When the condition of the patient is stabilized, he can go home, where it is possible to continue the antibiotics intravenously. A nurse can show the patient how to administer antibiotics and how to take care of catheter. The patient must be careful and tell the doctor about any new symptoms such as fever, chills and ask for advice on their appearance or other new symptoms.
If the patient has risk factors for developing endocarditis, antibiotics will be administered before medical or dental interventions or surgical procedures that can cause bacteria entering the bloodstream. A normal heart and normal valve structure decrease the risk of endocarditis. However, if there is a heart problem that causes abnormal blood flow, it increases the likelihood that bacteria or fungi to attach to heart tissue. This increases the risk of endocarditis. Some clinical conditions are at high risk: heart defects, heart valve defects, hypertrophic cardiomyopathy and artificial heart valves. Also, a history of endocarditis or AIDS or any state of immunosuppression (decreased ability of the body to fight infection) increase more the risk of developing endocarditis.
Patient should inform all clinicians who treat him about his condition before making any medical, dental or surgical intervention to risk exposing him to infection. You will probably need to take prophylactic antibiotics before dental surgery, surgical interventions in the area of the stomach, mouth, bowel, prostate or bladder. These interventions increase the risk of endocarditis.
Doctor may give the patient a card written as it needs antibiotic prophylaxis prior to undergo various medical procedures. If the patient has an increased risk of doing endocarditis, oral hygiene is very important. Brushing and flossing should be performed daily and routine dental checks should be done 2 times a year.