Endocarditis, Causes, Diagnosis, Treatment, Prevention, Complications

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.

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Endocarditis, Causes, Diagnosis, Treatment, Prevention, Complications

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, then attach to heart valves that are impaired or in damaged heart tissue. The 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 organs that are infected, for example due to open wounds 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 injecting drug use, tattooing, and 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 ever used injectable drugs
Have a weak immune system
Using a catheter in the long term
Have bad teeth and mouth conditions

Symptoms of Endocarditis

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:

Fever
shivers
Fatigue
Muscle and joint pain
Excessive sweating at night
Rapid heartbeat
Persistent cough
Swelling in the legs or abdomen
Headache
Shortness of breath, especially on exertion
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
dazed

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.

Endocarditis diagnosis

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 the types of germs in the body and measure levels of inflammatory 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 endocarditis has spread to the lungs and see if there is an enlarged heart
Echocardiography, to check for abnormalities in the heart using ultrasound
Scanning with a CT scan or MRI, to check whether the infection has spread to other organs, such as the brain or chest wall

Endocarditis Treatment

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:

Drugs

The medicines 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, the doctor will prescribe antifungal medication. In some cases, patients need to take antifungal drugs for life to prevent complications.

Operation

The operation is performed on patients whose heart valves have been damaged or those 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. Doctors can repair heart valves or replace them, 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 becomes disturbed
High fever continues despite being on antibiotic or antifungal therapy
Endocarditis is caused by aggressive types of fungi or bacteria that are resistant to antibiotics
An abscess or fistula (abnormal channel) appears inside 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 complications

Endocarditis can lead to the formation of blood clots and bacteria in the infected area. These clots can break off and move to other vital organs, such as the brain, lungs, kidneys or digestive 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
Strokes
seizures
Pulmonary embolism
Kidney damage
Enlarged spleen (splenomegaly)

Endocarditis Prevention

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 unsterile 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

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