Endocarditis is inflammation of the endocardium, which is the lining inside the heart. This inflammation is generally caused by bacteria, but can also be caused by viruses or fungi.
Endocarditis generally does not affect people with healthy hearts. This condition is most at risk for patients who have damaged heart valves, have undergone heart valve graft surgery, or have heart defects.
If not treated immediately, endocarditis can damage the heart valves and interfere with blood flow in the heart. This can lead to dangerous complications, such as heart failure or stroke.
Endocarditis is a rare inflammatory disease. This condition is only experienced by 3–10 out of every 100,000 people.
Causes of Endocarditis
Endocarditis occurs when germs enter the bloodstream leading to the heart, and then attach to heart valves that are affected or in damaged heart tissue. These germs then multiply in the inner lining of the heart (endocardium).
Germs that cause endocarditis can enter the bloodstream through:
- Teeth and mouth that are not cared for properly so that germs enter through the bleeding gums
- Other infected organs, for example due to open sores on the skin, sexually transmitted infections , or infections in the digestive tract
- Urinary catheters or infusion needles, especially those that have been installed for a long time, for example in stroke patients or dialysis
- Syringes contaminated with germs, both in the use of injecting drugs, tattooing, or piercing
Endocarditis risk factors
Anyone can experience endocarditis. However, there are several factors that can increase a person's risk of suffering from this condition, namely:
- Over 60 years old
- Using an artificial heart valve
- Have damage to the heart valves
- Suffering from congenital heart disease
- Using assistive devices on the heart, such as a pacemaker
- Have had endocarditis before
- Have you ever used injectable drugs?
- Have a weak immune system
- Using a catheter in the long term
- Having bad teeth and mouth
Symptoms of endocarditis can develop slowly over weeks or months ( subacute endocarditis ), or suddenly over a few days ( acute endocarditis ). This depends on the cause of the infection and whether the patient has heart problems.
Symptoms that can appear in patients with endocarditis are:
- Muscle and joint pain
- Excessive sweating at night
- Fast heart rate
- Cough constantly
- Swelling in the legs or abdomen
- Shortness of breath, especially when exercising
- Chest pain , especially when breathing
- Abnormal heart sound
- pale skin
In rare cases, other symptoms may also appear, such as:
- Weight loss
- Hematuria (blood in the urine)
- Red spots accompanied by pain in the palms or feet
- Red or purple bumps under the skin, fingers, or toes
- Red or purple spots on the skin, whites of the eyes, or inside the mouth
When to see a doctor
Immediately check with your doctor if you experience the symptoms mentioned above, especially if you have conditions that can increase the risk of developing endocarditis, such as congenital heart disease, or have had endocarditis before.
Early examination is needed so that endocarditis can be diagnosed immediately, considering that some of the symptoms are similar to flu symptoms.
To diagnose endocarditis, the doctor will first ask questions and answers about the symptoms experienced and the patient's medical history. After that, the doctor will carry out a thorough physical examination, including listening to the patient's heart sounds using a stethoscope.
Next, the doctor will carry out further tests to establish a diagnosis, such as:
- Blood tests, to detect types of germs in the body and measure levels of inflammation markers in the body, such as white blood cells
- Electrocardiogram (EKG), to detect abnormalities in heart rate and rhythm by measuring the heart's electrical activity
- Chest X-ray, to see if the endocarditis has spread to the lungs and see if the heart is enlarged
- Echocardiography , to check for abnormalities in the heart using ultrasound
- Scans with CT or MRI scans , to check if the infection has spread to other organs, such as the brain or chest wall
In many cases, endocarditis patients can be cured by administering drugs. Meanwhile, in some other cases, surgical procedures need to be performed to repair heart valve damage and clean up residual infection.
The following are endocarditis treatment methods:
The drugs given by the doctor will be adjusted to the type of germ that causes the infection. If the cause is bacteria, the patient will be given injectable antibiotics while in the hospital.
Hospital treatment may last 2–6 weeks, depending on the severity of the patient. If the condition has improved, the patient can continue antibiotic therapy at home. Even so, patients are encouraged to routinely control the doctor to ensure that the treatment is going well.
If endocarditis is caused by a fungus, your doctor will prescribe antifungal medication. In some cases, patients need to take antifungal drugs for life to prevent complications.
Surgery is performed on patients whose heart valves are damaged or who have had endocarditis for a long time. Surgery can also be performed on endocarditis caused by a fungal infection.
Surgery aims to remove dead tissue, fluid buildup, and scar tissue from the infected area. The doctor can repair the heart valve or replace it, depending on the patient's health condition.
Apart from the conditions above, the doctor will also suggest a surgical procedure if:
- Endocarditis causes heart failure so that blood flow is disrupted
- High fever continues despite being on antibiotic or antifungal therapy
- Endocarditis is caused by an aggressive type of fungus or bacteria that are resistant to antibiotics
- Abscess or fistula (abnormal channel) appears on the inside of the heart
- Endocarditis gives rise to blood clots
- The patient has a prosthetic heart valve
Of all cases of endocarditis, approximately 15–25% of patients require a surgical procedure.
Endocarditis can trigger the formation of blood clots and bacteria in the area of infection. These clots can break off and move to other vital organs, such as the brain, lungs, kidneys, or gastrointestinal tract.
If these conditions are not treated immediately, patients with endocarditis can experience complications, in the form of:
- Heart problems, such as heart valve damage and heart failure
- Abscesses or pockets filled with pus in the heart, brain, and lungs
- Pulmonary embolism
- Kidney damage
- Enlarged spleen (splenomegaly)
To prevent endocarditis, avoid exposure to germs that can cause infection. Efforts that can be made include:
- Maintain regular dental and oral hygiene
- Avoiding behaviors that can trigger infection, such as using unsterilized needles
- Carry out routine checks to the doctor if you have a history of previous endocarditis, have undergone heart valve graft surgery, or have congenital heart disease