What Is Endocarditis? Why Healthy Teeth Could Help Care For Your Heart

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Main Category: Heart Disease
Also Included In: Infectious Diseases / Bacteria / Viruses;  Cardiovascular / Cardiology
Article Date: 22 May 2009 - 1:00 PDT

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The word "endocarditis" comes from the word "endocardium". The endocardium is the innermost tunic of the heart, including the endothelium and subendothelial connective tissue; in the atrial wall, smooth muscle and numerous elastic fibers also occur.

Endocarditis is inflammation of the endocardium (Medilexicon's medical dictionary). In other words, it is the inflammation of the heart lining, heart muscles and heart valves. Endocarditis is a rare condition.

Endocarditis is also known as infective endocarditis, bacterial endocarditis, infectious endocarditis, and fungal endocarditis.

About the heart

The heart consists of four chambers and four valves - these are lines with a thin layer of cells (a membrane). This membrane is called the endocardium. An infection of the endocardium causes endocarditis. The infection is generally caused by the bacteria streptococci or staphylococci. Endocarditis can be caused by fungi or other infectious micro-organisms, but very rarely.

The heart of a person with endocarditis has clumps of bacteria and cells (vegetation) that form on the heart valves. This makes it harder for the heart to work properly. On occasions, the infection can spread to the kidneys, lungs, and brain. Abscesses can develop in the heart muscle in some cases.

How do you get endocarditis? What causes endocarditis?

An international study showed that infective endocarditis, infection and inflammation involving the heart valves is commonly associated with health care factors and is increasingly due to staphylococcal infection. Another study found that tongue studs raise a person's risk of developing endocarditis.

Normal daily activities, such as eating food, or brushing one's teeth, are opportunities for the bacteria or fungus to enter the human body and cause endocarditis. A dental or medical procedure that result in an infection could also be a cause. If your teeth and/or gums are in bad condition it is easier for the bacteria to get in. A study found that good dental hygiene helps prevent heart infection.

Bacteria that live in your mouth, upper respiratory tract or other parts of your body can cause endocarditis. Normally harmless, these organisms can attack the heart tissue and cause infection.

If an area of your body is already infected bacteria can sometimes spread, e.g. as might happen with a sore on your skin, or a gum disease that makes your gums bleed.

Sexually transmitted diseases, such as Chlamydia or gonorrhea make it easier for bacteria to get in and make their way to your heart.

Inflammatory bowel disease or any intestinal disorders may also increase risk. However, the risk is always very low as endocarditis is a rare condition.

Experts say that people with a heart defect are at much higher risk of developing endocarditis when the bacteria enter the body, especially if they have an abnormal heart valve or damaged heart tissue.

Procedures to examine internal organs which have food, such as the digestive tract, are also possible routes for the bacteria. If a colonoscopy leads to damage of the colon, that may trigger an infection which could give the bacteria a chance to spread. Other risk factors include procedures in the kidneys, bladder, urethra, the insertion of a urinary catheter, contaminated needles, and syringes.

Endocarditis is twice as common among men, than women. Although endocarditis can strike at any age, most cases occur with people over the age of 50.

Who is at higher risk of developing endocarditis?

• People with an existing heart condition or disease
• People who have had heart replacement surgery
• People who had a disease, such as rheumatic fever, which damaged at a heart valve
• People who have received a pacemaker
• People who have received drugs intravenously regularly
• People who are convalescing after a serious bacterial illness, such as meningitis or pneumonia
• People with chronically (long-term) suppressed immune systems, such as those with diabetes, HIV, cancer (chemotherapy recipients)

What are the symptoms of endocarditis?

In the majority of cases symptoms appear slowly over a period of several weeks, even several months. This period is called "sub-acute endocarditis". Rarely, though, symptoms may appear abruptly if the infection develops rapidly. When this happens, it is called "acute endocarditis". Patients with acute endocarditis tend to have more severe symptoms.

Endocarditis is very difficult to diagnose, and often doctors may take a long time to get the correct diagnosis. Symptoms may be more or less severe depending on the type of bacteria or fungi causing the infection. Patients with underlying heart problems tend to have more severe symptoms.

Many of the symptoms below may not be specific to endocarditis. Symptoms may include:

• A high temperature (fever)
• A new heart murmur
• Aching muscles (sometimes quite painful)
• Alterations in heart murmur
• Bleeding under fingernails or toenails
• Broken blood vessels in the eyes
• Broken blood vessels in the skin
• Chest pains
• Coughing
• Headache
• Shortness of breath (panting)
• Small lumps (nodules) on fingers and/or toes
• Sweating (this may include night sweats)
• Swelling of abdomen
• Swelling of limbs
• Tiredness (fatigue)
• Unexpected weight loss
• Weakness

How is endocarditis diagnosed?

The primary care physician (general practitioner, GP) will need to carefully check the patient's medical history and identify any possible heart problems, and recent medical procedures or tests. A medical procedure includes operations, biopsies, or endoscopies. The doctor will also check for fever, nodules, or any other signs and symptoms, such as a heart murmur, or an altered heart murmur if the patient already had one.

A series of tests may be used to confirm endocarditis. As the symptoms of endocarditis exist in so many other conditions and illnesses it can sometimes be a slow process of elimination before the endocarditis diagnosis is made. The following tests may be done:

• Blood culture test - to find out whether there are any bacteria or fungi in the patient's bloodstream. If any are found, they are usually tested with some antibiotics to find out which treatment is best.


• ESR (erythrocyte sedimentation rate) - this test finds out how fast the patient's blood falls to the bottom of a test tube full of liquid. The faster the blood falls to the bottom, the more likely it is that there is an inflammatory condition, such as endocarditis. The majority of patients with endocarditis have elevated ESR (blood reaches the bottom of the liquid faster than normal).


• Echocardiogram - sound waves produce images of the parts of the heart, including muscle, valves and chambers. This allows the doctor to look at the structure and workings of the patient's heart in more detail. Clumps of bacteria and cells (vegetations) can be identified with an echocardiogram, as well as infected or damaged heart tissue.


• CT Scan (computerized tomography) - x-rays are used to take pictures. A computer then puts all the images together. CT scans are good at spotting abscesses in the heart.

What is the treatment for endocarditis?

• Antibiotics - the majority of patients with endocarditis will receive a course of antibiotics. These will be administered through a drip (intravenously), so hospitalization is required. Regular blood tests will monitor the effectiveness of the medication. Patients can usually go home as soon as their temperature is back to normal and symptoms have subsided - however, they will probably have to continue taking antibiotics at home. In such cases, the patient should see his/her GP regularly to make sure the treatment is effective and that no side effects are undermining recovery.
  
  Antibiotics most commonly used are penicillin and gentamycin. Patients who are allergic to penicillin may be given vancomycin. Antibiotic treatment generally lasts from 2 to 6 weeks - this depends on many factors, but mainly on how severe the condition is.


• Surgery - if the endocarditis has damaged the heart the patient may have to undergo surgery. In the United Kingdom approximately 25% of all endocarditis patients have to undergo surgery. Surgery is recommended if:


• The heart valve is so damaged that it does not close tightly enough, and blood flows back into the heart (regurgitation).


• The patient does not respond to antibiotic or antifungal medication (the infection continues regardless).


• Large clumps of bacteria and cells (vegetations) are attached to a heart valve.


Surgery may repair the damaged heart valves or replace them with artificial ones, or drain the abscesses that have developed within the heart muscle.

What happens if endocarditis is left untreated, or if treatment is delayed?

The chances of complications are much greater. If the valves are damaged there is a growing risk of heart failure. Arrhythmia is another complication, because the heart's rhythms may be affected by endocarditis. As endocarditis is an infection, the infection itself can spread within the heart and to other parts of the body, such as the kidneys, lungs and the brain. If the vegetations break off they can be carried into the bloodstream to other parts of the body and cause infections and abscesses elsewhere. A vegetation that finds its way to the brain and gets stuck there can cause stroke or blindness. A large vegetation can get stuck in an artery and block bloodflow.

What is the prognosis?

If the patient receives the right treatment he/she has a 90% chance of making a full recovery. In severe cases, it can lead to death.

Written by - Christian Nordqvist
Copyright: Medical News Today
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