Endocarditis
Overview
Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves (native or prosthetic valves). Other structures which may be involved include the interventricular septum, the chordae tendinae, the mural endocardium, or even on intracardiac devices. Endocarditis is characterized by a prototypic lesion, the vegetation, which is a mass of platelets, fibrin, microcolonies of microorganisms, and scant inflammatory cells. In the subacute form of infective endocarditis, the vegegation may also include a center of granulomatous tissue, which may fibrose or calcify
Symptoms
Abnormal urine color Blood in the urine Chills Excessive sweating Fatigue Fever Heart murmur Joint pain Muscle aches and pains Night sweats Nail abnormalities (splinter hemorrhages under the nails) Paleness Red, painless skin spots on the palms and soles (Janeway lesions) Red, painful nodes in the pads of the fingers and toes (Osler's nodes) Shortness of breath with activity
Causes
Endocarditis can involve the heart muscle, heart valves, or lining of the heart. Most people who develop endocarditis have heart disease of the valves. Risk factors for developing endocarditis include: * Injection drug use * Permanent central venous access lines * Prior valve surgery * Recent dental surgery * Weakened valves Bacterial infection is the most common source of endocarditis. However, it can also be caused by fungi. In some cases, no cause can be identified.
Prevention
People with certain heart conditions often take preventive antibiotics before dental procedures or surgeries involving the respiratory, urinary, or intestinal tract. Those with a history of endocarditis should have continued medical follow-up.
Diagnosis
* CBC to check for anemia * Chest x-ray * Echocardiogram * ECG * Erythrocyte sedimentation rate (ESR) * Repeated blood culture and sensitivity * Serology * Transesophageal echocardiogram
Prognosis
Early treatment of endocarditis improves the chances of a good outcome. However, valve destruction or strokes can result in death.
Treatment
People with this condition will often need to be hospitalized at first to receive antibiotics through a vein (intravenously). Long-term antibiotic therapy is needed to get the bacteria out of the heart chambers and valves. Patients will usually have therapy for 6 weeks. The antibiotic must be specific for the organism causing the condition. This is determined by the blood culture and the sensitivity tests. Surgery to replace the heart valve is usually needed when: * The infection is breaking off in little pieces, resulting in a series of strokes * The person develops heart failure as a result of damaged heart valves