Endocarditis (Bacterial Or Infective)

General Illness Information

Medical Term:
ENDOCARDITIS (Bacterial or Infective endocarditis)

Common Name: None Specified

Description: Infective endocarditis is a serious infection of the endocardium (the smooth interior lining of the heart ) and the heart valves. It is mostly caused by bacteria. Rarely, can be caused by fungi or other organisms.

May be acute or sub acute. Infective endocarditis can come on suddenly and become life-threatening within a matter of days and is called acute infective endocarditis. Subacute endocarditis usually develops gradually and subtly over a period of weeks to several months. It is always fatal if untreated. Infective endocarditis is not contagious.

Causes: Usually a bacterial infection. This may present in two ways:

  • Acute Bacterial Endocarditis, mainly caused by staphylococci, or streptococci, or pneumococci or gonococci.
  • The Subacute (SBE) illness mostly caused by other streptococci or haemophilus bacteria. In 5 to 10% of cases fungal infection or some rare bacteria may be the cause of endocarditis and in this group the blood cultures are negative.

Bacteria are not normally found in the blood but may enter the body by various means such as intravenous drug use, cardiac catheterization and other invasive procedures, cuts, bruises and minor surgical procedures, dental procedures etc. In susceptible individuals, this is followed by blood stream spread and infection of the inner lining of the heart and the heart valves. Susceptible people are those listed under risk factors.

Prevention:

  • If you have heart-valve damage or a heart murmur: Request antibiotics prior to medical procedures that may introduce bacteria into the blood. These include dental work, childbirth and surgery of the urinary or gastrointestinal tract. It is also important to maintain good oral hygiene.
  • Consume alcohol in moderation. Don’t use illicit drugs like heroin or cocaine. Consult medical professional before becoming pregnant.

Signs & Symptoms

Subacute bacterial endocarditis (SBE) has an insidious onset and may have some or all of all of the following symptoms:

  • Intermittent low-grade fever, chills and excessive sweating, especially at night.
  • Fatigue and weakness.
  • Vague aches and joint pains. Back pain, may be severe.
  • Heart murmur.
  • Weight loss.

Late stages:

  • Severe chills and high fever.
  • Shortness of breath on exertion.
  • Swelling of the feet, legs and abdomen
  • Rapid or irregular heartbeat.
  • Symptoms and signs caused by the complications of the disease. (See Below)
  • Acute bacterial endocarditis (ABE) has similar symptoms, but the course is much more rapid.

Risk Factors

Risk of endocarditis increases with:

  • Rheumatic fever, rheumatic heart disease.
  • Congenital heart disease.
  • Injections of contaminated materials into the bloodstream, such as with self-administered intravenous drugs
  • Invasive procedures such as cardiac catheterizations, intravenous lines and catheters etc.
  • Pregnancy.
  • Excess alcohol consumption.
  • Artificial heart valves.
  • Use of immunosuppressive drugs.
  • Mitral valve prolapse.
  • Minor surgical procedures, such as dental work, in susceptible individuals.

Diagnosis & Treatment

A physician may suspect endocarditis based on symptoms alone ,especially in a patient with a predisposing condition. Patients suspected of having acute bacterial endocarditis are usually hospitalized promptly for diagnosis and treatment.

Diagnostic tests may include laboratory blood counts and blood cultures, electrocardiogram, X-rays of the heart and lungs, including echocardiogram.

General Measures:

  • The goal of treatment is to eradicate the infecting organism with medications and supportive care for relieving symptoms.
  • Hospital care during acute phase. Once stable, some patients can continue with treatment at home
  • Surgery to replace infected valve in patients in whom antibiotics have not been effective or in patients with artificial heart valves, or in patients with dramatically worsening symptoms.
  • If you have damaged heart valves or if you are on immunosuppressive medications, tell your doctor or dentist prior to any treatment or procedure. Preventive antibiotics will be needed for medical and dental procedures.

Medications:

Antibiotics for many weeks to fight infection. Antibiotic treatment is often intravenous.

Activity:

Rest in bed until you are fully recovered. While in bed, flex your legs often to prevent clots from forming in deep veins. Resume your normal activities, including sexual relations when strength allows.

Diet:

No special diet.

Possible Complications :

  • Infected blood clots that may travel to the brain, kidneys, or abdominal organs causing infections, abscesses or stroke
  • Heart-rhythm disturbances (atrial fibrillation is most common)
  • Destruction of heart valves
  • Lung clots may appear
  • Arthritis
  • Myositis ( inflammation of muscles)
  • Acute renal failure

Prognosis

Usually curable with early diagnosis and treatment, but recovery may take weeks. If treatment is delayed, heart function deteriorates, resulting in congestive heart failure and death.

Other

‘Nothing Specified’.

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