Infective Endocarditis

The endocardium is the membrane that covers the interior of your heart’s four chambers and valves. For infective endocarditis to occur, your heart must have a place where the infecting organism can lodge and reproduce; thus, if you have a normal, healthy heart, you are unlikely to contract infective endocarditis.

However, you are at risk for this disease if you were born with a malformed heart or heart valves or if your heart valves have become scarred from rheumatic fever .You are also at risk if one of your valves was replaced with a mechanical valve. Such problems may mean that you have a roughened and abnormal surface within your heart where the infecting organisms can congregate, multiply, and potentially spread to other parts of your body.

Certain bacteria that commonly inhabit the mouth and upper respiratory tract may cause endocarditis. They may enter the bloodstream during a dental or surgical procedure such as a tooth extraction, tonsillectomy, or other operation that involves bleeding in the mouth or throat. Intestinal bacteria, called enterococci, may enter your bloodstream during an instrumental examination or surgery in areas such as the prostate, bladder, rectum, or female pelvic organs. Drug addicts who inject drugs into a vein with unsterilized needles also are vulnerable.

Signs and Symptoms

1. Fever
2. Unusual fatigue or loss of appetite
3. Heart murmur;
4. Night sweats, chills.

Diagnosis:

Endocarditis may develop rapidly, usually with fever and chills, but this is not always the case, especially in elderly people. You may experience any one of various other symptoms including night sweats, malaise, fatigue, loss of appetite and weight, and joint inflammation. When the infection develops more slowly, your physician will look for such symptoms as an abnormally rapid heart rate (tachycardia), enlargement of the spleen, pallor or a yellow-brown color to the skin, tiny red spots on the skin and mucous membranes, and heart murmurs (abnormal sounds over the heart).

Your physician will order a series of blood cultures to determine which microorganism is causing the infection.

Problems and complications of Infective Endocarditis:

Infective endocarditis is fatal without treatment and elimination of the infection. Because the illness usually occurs in people who already have heart disease, the outcome depends largely on whether complications occur. Even if you are cured of the bacterial infection, you may have continued heart symptoms for years after treatment. Complications such as cardiac or renal failure may develop as well.

Treatment:

Prevention: Even with the availability of powerful modern antibiotics, treatment can be difficult and the results uncertain. Thus, prevention is the best approach.You are susceptible to infective endocarditis if:

1. You were born with a malformed heart or heart valve;
2. Your heart valves were scarred by rheumatic fever;
3. You have an artificial heart valve.

Even if the cardiac problem is minor and has never caused any difficulty or if the cardiac defect has been repaired and you feel entirely healthy, you still are at risk for this potentially life threatening infection. Antibiotics offer protection from infective endocarditis by destroying or controlling bacteria. Use of such drugs may be advisable before and after certain procedures during which bacteria could enter your bloodstream, travel to your heart, and cause an infection there.

If you are at risk, follow these recommendations:

1. If you are to undergo any procedure on your mouth  or throat that may cause bleeding, your physician or dentist probably will prescribe penicillin for oral administration. If you are allergic to penicillin, an alternative antibiotic such as erythromycin may be substituted. If you have already had heart valve surgery, an injectable antibiotic may be necessary.
2. If you are to undergo Urological or Gastrointestinal Surgery or Examination With  Instruments, Appropriate preventive measures may include a combination of injectable antibiotics just prior to and again 8 hours after the procedure.

Medication:

Antibiotic therapy depends on the type of microorganism causing the disease. Cultures of the blood are used to determine which antibiotic is appropriate; often, a combination of antibiotics is used, with penicillin commonly being one of them. The medication is often injected directly into a vein and may be given continuously over a period of several weeks to eradicate the infection.

Surgery:

If the infection causes major damage to the heart valves, valve replacement may be necessary.