Infective endocarditis
Summary/Definition
Endocarditis is a condition in which there is inflammation of the endocardium and peridermal (the tissue surrounding the vascular bundle) due to bacterial invasion through certain channels or haemorrhage in the heart cavity. This condition occurs as a result of a bacterial infection that leads to inflammatory changes in the heart valves. There is a high likelihood of endocardial ulcers that can restrict normal blood flow, especially in the presence of abnormalities in the structure of the heart or the presence of artificial valves, as well as other heart conditions that may carry a risk of bacterial infection of the endocardium or valve. Bacterial infections can infiltrate damaged endocardial areas. Untimely diagnosis and treatment can lead to several serious complications, such as heart failure and other cardiac complications. In cases of infection of natural or artificial valves, endocarditis is subdivided into natural and artificial valve endocarditis. In terms of the chronology of the disease, acute and subacute endocarditis can be distinguished according to the clinical severity, the speed of diagnosis and the nature of the course of the disease. Acute endocarditis is characterized by rapid development and frequent infections, which can lead to sudden damage to heart tissue. In contrast, subacute endocarditis is characterized by slower progression and infrequent infections.
Endocarditis can be classified into three categories: artificial valve endocarditis, natural valve endocarditis in drug-dependent individuals and natural valve endocarditis defined according to the condition of the patient’s aortic valve, depending on the type of bacteria that is the underlying cause of the disease and clinical diagnosis. The basis for this classification is that the entry of pathogens such as Gram-negative bacteria, staphylococci, streptococci and others into the bloodstream represents a major risk factor for the development of endocarditis. This can be particularly dangerous in heart valves with developmental anomalies (congenital heart defects, rheumocarditis or cases of valve transplantation).
Symptoms
In acute endocarditis, there are symptoms similar to a cold, such as fever, sweating, muscle aches, general weakness, etc. An acute endocarditis is more common in the elderly, especially those with marked general weakness. In patients with symptoms of renal failure, acute endocarditis may present without fever. Chronic endocarditis, which is characterized by symptoms occurring over several months, may include chills, fever, excessive fatigue, weight loss, muscle pain, and arthralgias. Patients with chronic endocarditis and renal dysfunction may present with oedema and pink sputum. An acute endocarditis, which is often associated with toxic bacteria such as staphylococcus or mould fungi, is accompanied by acute symptoms such as decreased high blood pressure, chills, hypertension, etc. In this case, the valve quickly loses its function and requires urgent treatment. In addition, lumbar pain, arthralgia, headache, and sometimes bruising of the upper and lower extremities may occur. When the valve is destroyed, endocarditis is accompanied by dyspnoea and other symptoms.
Diagnostics
People with a medical history of congenital heart disease, rheumocarditis, valve disease and other abnormalities should be vigilant and should not rule out the possibility of endocarditis in the presence of cold-like symptoms such as fever, etc. The physical examination analyses the presence of unusual heart sounds and checks for signs of characteristic changes in the skin. If the diagnosis of endocarditis is in doubt, a bacteriological examination is required to confirm the diagnosis by drawing blood from veins in other parts of the body. More than 95% of cases of endocarditis can be detected by blood tests. Determining the type of bacteria and choosing the appropriate antibiotic play an important role in the treatment of endocarditis. For a more detailed diagnosis of endocarditis, echocardiography is performed to assess the extent of bacterial growth, the presence of valve regurgitation and possible ventricular dysfunction. To further clarify the diagnosis, blood tests for bacterial growth may be performed, as well as urine tests for red blood cells, protein and other indicators that may be important in the final diagnosis by a specialist.
Treatment and course of the disease
One of the most important aspects in considering the likelihood of endocarditis is the identification of the specific strain that is the underlying cause of the disease. By analysing the distribution of bacteria in the blood, it is determined which microorganisms caused the infection, so that the most effective antibiotic against that particular strain can be selected. A course of treatment with intravenous drugs is then given for 4-6 weeks. In total, the use of antibiotics is continued for 6-8 weeks with regular blood tests and echocardiographic studies to monitor the dynamics of the disease. When damage to the heart valve due to bacterial growth is detected, surgical intervention may be required.
