What is infective endocarditis
Infective endocarditis (IE) is an inflammatory condition that can cause death and affects the lining of your heart valves and occasionally the heart chambers. This happens when bacteria or other microorganisms from other parts of your body enter your circulation, adhere to, and damage the lining of your heart valves or chambers. Bacterial endocarditis (BE), acute, subacute (SBE) or chronic bacterial endocarditis are other names for infectious endocarditis.
Causes of infective endocarditis
Infective endocarditis is usually caused by bacteria. These microscopic invaders can enter your bloodstream through various ways, including:
- Dental procedures: Poor dental hygiene or invasive dental work like tooth extractions can allow bacteria to enter the bloodstream.
- Intravenous drug use: Sharing needles or using non-sterile equipment can expose the bloodstream to bacteria.
- Catheter-related infections: Long-term use of intravenous catheters or other medical devices can increase the risk of bacterial entry.
- Heart valve abnormalities: Individuals with congenital heart defects or prosthetic heart valves are more susceptible to developing infective endocarditis.
- Medical procedures: Certain procedures like urinary tract catheterization or surgery on infected tissues can introduce bacteria.
- Skin infections: Untreated wounds or infections can provide an entry point for bacteria.
- Weakened immune system: Conditions like HIV/AIDS or long-term steroid use can impair your body's ability to fight off infections.
What are the symptoms of infective endocarditis?
The symptoms of infective endocarditis can vary depending on the severity of the infection and the underlying health of the individual. Common symptoms include:
- Fever
- Fatigue
- Heart murmurs (abnormal heart sounds)
- Shortness of breath
- Unintentional weight loss
- Joint pain
- Night sweats
If you experience any of these symptoms, it is important to seek medical attention promptly, as early diagnosis and treatment are vital for a positive outcome.
Infective endocarditis diagnosis
In its initial stages, infective endocarditis often exhibits symptoms that resemble those of other illnesses, posing challenges for accurate diagnosis.
To identify endocarditis, the following diagnostic procedures are commonly employed:
- Medical history: Understanding the patient's medical history is crucial. Individuals with a history of heart valve abnormalities, prosthetic heart valves, intravenous drug use, or recent dental procedures are at an increased risk of infective endocarditis.
- Blood tests: Complete blood count (CBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) tests may be conducted to assess the overall inflammatory response in the body.
- Urinalysis: Urinalysis may be performed to check for signs of kidney involvement or other abnormalities.
- Echocardiography: Echocardiograms, including transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE), are essential imaging studies. TEE, which involves inserting a probe into the esophagus, provides a more detailed view of the heart structures and is particularly useful for detecting small vegetations or complications.
- An electrocardiogram (ECG) is employed to assess for abnormal heart rhythms.
- A chest X-ray is performed to examine for the presence of fluid accumulation in the lungs.
- An MRI scan is employed to obtain clearer images of the heart.
Given the severity of endocarditis as an infection, doctors may opt to initiate treatment promptly while simultaneously undertaking measures to confirm the diagnosis.
Treatment of infective endocarditis
Typically, the treatment regimen involves a duration of at least two weeks, often extending up to eight weeks, during which high doses of intravenous antibiotics are administered. While the initial phase of antibiotic therapy is commonly initiated in a hospital setting, it may be achieved at home with the assistance of a nurse. Certain individuals with specific infections may transition to oral antibiotics following an initial period of intravenous treatment.
It's essential to recognize that antibiotics alone may not always provide a complete cure, especially when dealing with infections affecting replaced valves. One contributing factor is the resistance of bacteria causing endocarditis in individuals with replacement valves to antibiotics, as pre-surgery antibiotic prophylaxis might selectively allow resistant bacteria to survive. Additionally, the inherent challenge of eradicating infections on artificial, implanted materials compared to human tissue can hinder the effectiveness of antibiotic treatment.
In instances where antibiotic therapy proves ineffective, significant valve leakage occurs, or congenital defects link different heart chambers, heart surgery may become necessary. This surgical intervention could involve repairing or replacing damaged valves, removing vegetations, or draining abscesses.
Dental treatment plays a crucial role in eliminating potential sources of infection stemming from oral or gum diseases. Medical practitioners often remove any devices, such as catheters, that could serve as infection sources.
Throughout the treatment process, doctors employ echocardiography examinations to monitor the reduction of the infected area. Post-treatment, echocardiography serves to document the condition of heart valves, as infective endocarditis carries a risk of recurrence. Given this risk, ongoing dental care and maintaining good skin hygiene are imperative to prevent bacterial entry through wounds or sores.
