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Original Editor - Audrey Brown
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Introduction[edit | edit source]

Endocarditis is a rare and potentially fatal inflammation of the inner lining of the heart chambers and valves. This lining is known as the endocardium. [1]

Clinically Relevant Anatomy[edit | edit source]

Endocarditis may involve the inner lining of the heart, the heart valves, and/or the heart muscle.

Pathological Process[edit | edit source]

Endocarditis is most commonly caused by a bacterial infection. Endocarditis begins when bacteria enter the bloodstream via several methods including central venous access lines, injectable drug use using unsterile needles, recent dental surgery, other surgeries or minor procedures involving the respiratory tract, urinary tract, infected skin, or orthopedics.[1]

It can also be rarely caused by a fungal infection. In some cases, no direct cause can be found.[1]

The bacteria within the heart can accumulate at the site of the infection, creating small clumps. These clumps act similarly to blood clots and can travel away from the heart to cause stroke in the brain or block blood supply to organs.[2]

Clinical Presentation[edit | edit source]

Patients with the following factors are at higher risk for developing infectious endocarditis:

  • Birth defects of the heart
  • Heart transplant and valve problems (such as valvular stenosis or valvular regurgitation)
  • Prosthetic heart valves
  • Past history of endocarditis
  • Dental procedures that are likely to cause bleeding
  • Surgical procedures involving the breathing tract, the urinary tract system, and/or the digestive tract.
  • Surgical produces on skin infections and soft tissue infections
  • Hypertrophic cardiomyopathy [2]
  • Hypertension[2]

Endocarditis is also more common in patients over the age of 50 and men are twice as likely to be affected as women.[2]

The symptoms of endocarditis commonly include fever, chills, and sweating.[1]These symptoms may be inconsistent, but are usually present for days before other symptoms of endocarditis present and may be more noticeable at night.

Other symptoms of endocarditis may include:[1]

  • Small areas of bleeding under the nails (Splinter Hemorrhages)
  • Red, painless skin spots on palms and soles of feet (Janeway Lesions)
  • Red, painful nodes in the pads of fingers and toes (Osler nodes)
  • Shortness of breath with activity
  • Swelling in feet, legs, and abdomen
  • Fatigue
  • Weakness
  • Aches and/or pains in muscles and joints

Diagnostic Procedures[edit | edit source]

Patients with endocarditis may present with a new heart murmur or a change in a past heart murmur.

Other testing for endocarditis involves blood cultures to identify the bacteria or fungus causing the infection, complete blood count (CBC), C-reactive protein counts (CRP), and erythrocyte sedimentation rates (ESR). An echocardiogram may also be performed to examine the heart valves.[1]Blood testing is important to help diagnose the most effective treatment.[2]

Management / Intervention[edit | edit source]

Endocarditis is a potentially life-threatening condition and emergency medical intervention and hospitalization may be necessary.

Patients with endocarditis require long-term antibiotic therapy for 4-6 weeks to eliminate all bacteria within the heart chambers and valves.

Surgery is often indicated in the following situations where endocarditis can cause more serious health conditions:[1]

  • The infection breaks off into small pieces, increasing the risk for strokes
  • The patient develops heart failure as a result of damaged heart valves
  • Severe organ damage (ex. heart damage)

The prognosis for endocarditis generally improves with time-to-treatment. If endocarditis is not treated in a timely manner, the patient may develop brain abscesses, further damage to heart valves, spread of the infection to other parts of the body, or stroke.[1]

Prevention[edit | edit source]

Preventative measure to limit infection exposure should be taken to decrease the risk of developing endocarditis. [2]

Patients at risk of developing endocarditis should:

  • Practice good oral hygiene, especially addressing abscesses and gum disease, to minimize the risk of bacteria entering the blood stream via the mouth
  • Skin Checks, including washing the skin regularly with an antibacterial soap, and addressing symptoms of skin infections

It is important to note that antibiotics should only be used when necessary to reduce the risk of VRSA and MRSA.[2]

Resources[edit | edit source]

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References[edit | edit source]