Endocarditis (inflammation of the inner lining of the heart) – causes, symptoms & therapy

Endocarditis is inflammation of the lining of the heart (endocardium). This thin and smooth skin is the innermost tissue layer of the heart wall. It lines the heart (heart cavities) from the inside and the heart valves also consist of endocardium. There are two different types of endocarditis.

Bacterial endocarditis is caused by infection with bacteria . A distinction is made between aggressive acute bacterial endocarditis and the much milder subacute variant. The second type of disease is post-infectious or rheumatic endocarditis, which can occur as a result of rheumatic fever.

causes

The cause of bacterial endocarditis is an infection with bacteria that are either introduced into the blood system from outside or originate from foci of inflammation in the body. This can involve very small, unnoticed inflammations in organs, such as in the urinary tract or in the gastrointestinal tract.If the bacteria get into the body from outside, this usually happens through medical interventions. There is a risk of bacterial endocarditis, especially during heart surgery.

Bacteria can also get into the bloodstream via central venous catheters, but also when injecting drugs. The germs reside on the skin, where they are completely harmless. They only trigger inflammation in the blood.

Rheumatic endocarditis can result from rheumatic fever, which can develop as a complication after tonsillitis or pharyngitis. Rheumatic fever is an autoimmune disease in which antibodies that originally formed to fight off the bacteria are now directed against the body’s own cells, such as the heart muscle cells.

When to the doctor?

A doctor should be consulted as soon as the affected person notices heart murmurs. Because these are considered unusual and worrisome, they need to be investigated and treated. In the case of fever, tiredness , exhaustion and general malaise, it is necessary to consult a doctor. If you feel pain in your body, especially headaches and body aches, see a doctor if it lasts for several days.

Before taking pain medication, you should also consult a doctor to avoid possible side effects. If there is a feeling of pressure in the area of ​​the heart as well as stabbing and pulling pains, the symptoms should be clarified immediately by a doctor. If there are disturbances in the heart rhythm, tachycardia , chills and unexplained sweating, a doctor must be consulted.

If it is found upon waking in the morning that there was profuse night sweats, this symptom should be presented to a doctor if it occurs repeatedly and cannot be attributed to sleeping conditions that are too warm. Loss of appetite, reduced performance and weakness are also alarming indicators that should lead to a doctor’s visit. Changes in the complexion, sensitivity of the skin to touch or temperature influences and redness must be examined by a doctor if they occur for inexplicable and incomprehensible reasons.

symptoms and course

Endocarditis usually begins with fever and general symptoms such as exhaustion , headache and body aches and loss of appetite . The subacute form of bacterial endocarditis shows significantly less symptoms than the aggressive acute bacterial endocarditis. It occurs very suddenly, with severe symptoms, while the subacute form begins more slowly.

Rheumatic endocarditis mostly affects children and adolescents and often goes undetected at first. In the further course of endocarditis, changed or new additional heart sounds develop. If the endocarditis is not recognized, it can lead to embolism (clotting of vessels by a blood clot), an abscess (collection of pus) in the heart or the destruction of the heart valves and thus to a life-threatening condition.

Diagnose

The diagnosis of endocarditis is initially initiated by recording the history of the disease. It is important to note whether a previous illness or defects in the heart valves and heart are already known. This is followed by a thorough physical examination and listening to the heart sounds.

If endocarditis is present, the doctor will be able to clearly hear the changed heart sounds. A blood test can confirm the diagnosis. For this purpose, a blood sample is examined for any inflammatory markers that may be present and a so-called blood culture is created. In this case, the blood sample remains in a warming cabinet for several days. If bacteria are present, they will multiply under these conditions and are then identifiable.

In the case of rheumatic endocarditis, the antibodies can also be detected in the blood. An ultrasound examination (sonography) and an ECG (electrocardiography) can also be used to confirm the suspicion of endocarditis.

treatment and therapy

Endocarditis is initially treated with high doses of antibiotics . This is usually done via an IV in the hospital. It is important that the pathogen has been determined beforehand, because in order to achieve the best effect, the antibiotic must be tailored to the bacteria present.

A mixture of several antibiotics is often given. In any case, treatment must be started as early as possible so that the heart and valves are not damaged too severely. Bed rest must be maintained during antibiotic treatment to protect the body. The therapy usually lasts four to six weeks.If endocarditis is diagnosed late and has already caused damage to the heart valves, an operation is usually unavoidable. During this procedure, the damaged heart valve is either repaired, or it is removed and replaced with an artificial (made of plastic or metal) or biological (made of animal or human material).

In the past, this operation always had to be performed on an open heart, but today it is also possible to insert heart valves into the heart using a catheter. The new heart valve is folded and pushed over the catheter into the heart and stretched over the old valve. There it then overlays the defective flap and takes over its task. This procedure is much gentler on the patient than the open heart surgery that used to be common for endocarditis.

prevention

Endocarditis can be partially prevented. If you belong to a risk group, i.e. if you already have heart or heart valve diseases, it is advisable to take antibiotics as a preventive measure before surgical interventions, especially in the mouth and throat area, in order to avoid endocarditis.