Endocarditis

Endocarditis refers to inflammation of the inner lining of the heart's valves and chambers (endocardium). It is a rare but potentially life-threatening condition.

Based on its progression, endocarditis is classified into two types:

• Acute endocarditis: Develops suddenly and can be fatal within days.
• Subacute endocarditis: Progresses gradually over weeks or months and can also be life-threatening.

In most cases, endocarditis is caused by an infection that reaches the heart through the bloodstream. It typically affects previously damaged tissues due to a congenital defect, an autoimmune disease, a cardiac catheterization, or the presence of artificial valves (prosthetic valve endocarditis). However, if the germs are highly aggressive or present in large quantities, they can infect healthy valves and tissues.

Symptoms

The most common symptoms of endocarditis include:

• Persistent fever
• Rapid heart rate
• Fatigue and weakness
• Shortness of breath (dyspnea)
• Excessive sweating, especially at night
• Heart murmur (a whooshing sound in the heart)
• Swelling in the legs, feet, and abdomen
• Joint and muscle pain
• Unexplained weight loss
• Blood in the urine or abnormal urine color
• Janeway lesions: painless red, purple, or brown spots on the soles of the feet
• Osler’s nodes: painful reddish or purple lumps on the fingertips or toes
• Petechiae: small round red, brown, or purple spots on the skin, in the whites of the eyes, or inside the mouth

Causes

Based on its origin, endocarditis is classified into two types:

• Infectious endocarditis: Caused by bacteria, fungi, or other germs infecting another part of the body, usually the mouth, skin, or respiratory tract. If these microorganisms enter the bloodstream, they can travel to the heart, where they adhere to the valves or cardiac tissue and accumulate, forming masses (vegetations).
• Non-infectious or marantic endocarditis: Caused by the formation of fibrous blood clots without microorganisms (sterile vegetations) on already damaged heart valves.

Risk Factors

Factors that increase the likelihood of developing infectious endocarditis include:

• Weakened immune system
• Intravenous drug use
• Presence of a prosthetic valve, pacemaker, or defibrillator
• Congenital heart defects
• Valvular heart disease
• Aging, as heart valves deteriorate over time
• Dental or oral conditions, such as wounds or gingivitis
• Poor oral hygiene
• Recent catheterization procedures

For non-infectious endocarditis, common risk factors include:

• Immune disorders
• Lung, stomach, or pancreatic cancer
• Conditions causing excessive blood clotting, such as sepsis, uremia, or disseminated intravascular coagulation

Complications

Infectious endocarditis (which is fatal if left untreated) can lead to the formation of vegetations that detach and travel through the bloodstream, blocking blood vessels or spreading the infection to other organs. These complications may result in:

• Stroke
• Heart failure
• Abscess formation
• Pulmonary embolism
• Heart attack
• Kidney damage

In cases of prosthetic valve endocarditis, the infection may spread to the heart muscle, leading to:

• Detachment of the valve from the heart
• Interruption of the heart’s electrical conduction system, causing a reduced heart rate
• Sudden loss of consciousness or even death

Non-infectious endocarditis can present the same complications as infectious endocarditis, but in this case, due to the detachment of a blood clot that blocks an artery.

Overall, due to the severity of underlying conditions, this disease has a poor prognosis.

Prevention

Infectious endocarditis can be prevented by reducing the risk of infection:

• Proper cleaning and care of wounds and skin burns
• Good oral and personal hygiene, including frequent hand washing
• Avoiding intravenous drug use
• Preventive antibiotic administration before undergoing invasive medical procedures such as surgeries, catheterizations, or dental extractions and prostheses, especially in individuals at risk for endocarditis

Which Doctor Treats Endocarditis?

Endocarditis is evaluated and treated in cardiology and cardiovascular surgery units.