We recently had a friend contract Endocarditis. Before his diagnosis, he had never heard of Endocarditis, and we felt it was something that many of our community members would want to learn more about! So we reached out to him to learn more about his experience. After learning more, we thought it would be beneficial to share what we learned with our community
What is Endocarditis?
Endocarditis is an infection of the valves of the heart. As a result, those people with structurally abnormal hearts (artificial heart valves, congenital heart defects, or previous heart surgery) are at risk. Likewise a history of illicit intravenous drugs or patients who recently had bacteria in their bloodstream (bacteremia) are at a significantly higher risk of contracting endocarditis.
Endocarditis is characterized by lesions, which are known as vegetations which contain bacteria, that are adherent to the valves in the heart. Once the vegetations stick to the valves, it may cause the bacteria to spread to other organs and cause infection in those organs as well. The diagnosis of endocarditis is based on clinical features, imaging of the heart with an ultrasound machine (echocardiogram), and blood cultures demonstrating the growth of the bacteria in the bloodstream. Because there are not normally bacteria or fungi in blood, blood cultures will typically show if there are any abnormal microorganisms in your blood.
If a bacterial infection is causing endocarditis, your doctor will prescribe one or more antibiotics for prolonged duration (typically 6 to 8 weeks). These antibiotics often have to be given by intravenous (IV) infusion directly into the bloodstream. The duration and intensity of treatment depends on the severity of the infection and the type of bacterial organism that is responsible for the endocarditis. Since treatment may last 6 to 8 weeks, generally, a PICC line will be inserted to receive IV treatment. In addition to medical therapy with IV antibiotics at times surgical options are required to repair or replace the infected heart valve.
Causes of Endocarditis
Risk factors for people who develop endocarditis have a:
- Birth defect of the heart
- Damaged or abnormal heart valves
- History of endocarditis
- New heart valve after surgery
- Indwelling catheters
- Chronic Hemodialysis
- Immunosupressed state (HIV, Chemotherapy, etc)
Infective Endocarditis begins when germs enter the bloodstream and then travel to the heart.
- A bacterial infection is the most common cause of endocarditis.
- Endocarditis can also be caused by fungi, such as Candida.
- In some cases, no cause can be found.
Germs are most likely to enter the bloodstream by:
- Central venous access lines
- Injection drug use, from the use of unclean (unsterile) needles
- Recent dental surgery
- Other surgeries or minor procedures to the respiratory tract, urinary tract, infected skin, or bones and muscles
Symptoms of Endocarditis
Symptoms of endocarditis may develop slowly or suddenly. Fever, chills, and sweating are frequent symptoms. These sometimes can be present for days before any other symptoms appear. They can also come and go or be more noticeable at nighttime. You may also have fatigue, weakness, and aches and pains in the muscles or joints. Other signs can include:
- Small areas of bleeding under the nails (also known assplinter hemorrhages)
- Red, painless skin spots on the palms and soles (Janeway lesions)
- Red, painful nodes in the pads of the fingers and toes (Osler's nodes)
- Shortness of breath with activity
- Swelling of feet, legs, abdomen
If you have these symptoms, please contact your health provider
Exams and Tests to Help Determine Whether You Have Endocarditis
There are several issues that your health provider may detect. Your health care provider may detect a new heart murmur, or a change in a past heart murmur. A murmur is an abnormal sound that your doctor will hear between beats of your heart when they listent to your heart during a physician exam. An eye exam may show bleeding in the retina and a central area of clearing. This finding is known as Roth's spots.
Tests that may be done include:
- Blood culture to help identify the bacteria or fungus that is causing the infection
- Complete blood count (CBC), C-reactive protein (CRP), or erythrocyte sedimentation rate (ESR)
- A routine echocardiogram or a transesophageal echocardiogram to look at the heart valves
You may need to be in a hospital to receive IV antibiotics. Blood cultures and tests will help your provider choose the best antibiotic. You will then need long-term antibiotic therapy. People most often need therapy for 6 to 8 weeks to fully kill all the bacteria from the heart chambers and valves. The exact duration of antibiotics will be determined by your doctor. Antibiotic treatments that are started in the hospital will need to be continued at home. Surgery can be utilized to replace the heart valve.
Getting treatment for endocarditis right away improves the chances of a positive outcome. However, ignoring symptoms can result in more serious problems. Problems that may develop include:
- Brain abscess (pocket of puss in the brain)
- Further damage to the heart valves, causing heart failure
- Spread of the infection to other parts of the body
- Stroke, caused by small clots or pieces of the infection breaking off and traveling to the brain
When to Contact a Medical Professional
Call your health care provider if you notice the following symptoms during or after treatment:
- Shortness of Breath
- Chest pain
- Weight loss without a change in diet
- Or any other new or concerning symptoms
How Can You Prevent Endocarditis?
TheAmerican Heart Associationrecommends preventive antibiotics for people at risk for infectious endocarditis, such as those with:
- Certain birth defects of the heart
- Heart transplant and valve problems
- Man-made (prosthetic) heart valves
- Past history of endocarditis
These people should receive antibiotics when they have:
- Dental procedures that are likely to cause bleeding
- Procedures involving the breathing tract
- Procedures involving the urinary tract system
- Procedures involving the digestive tract
- Procedures on skin infections and soft tissue infections
Not all cases of endocarditis can be prevented because we do not always know when a bacteremia occurs. However, there are steps that can be taken to lower the risk and likelihood of contracted endocarditis.
For patients whose heart conditions put them at the highest risk for adverse events from infective endocarditis, theAmerican Heart Associationrecommends antibiotics before certain dental procedures. However, for most patients, antibiotics are not needed. Taking proper care of your teeth and gums is the single most important preventative measure you can take. The mouth is a common source of bacteria that can cause infection. Keeping your mouth clean and healthy while maintaining regular dental care will also help reduce the chance of bacteremia from routine daily activities. Early treatment of endocarditis symptoms will help reduce the severity of future treatments.
Care+Wear is committed to helping patients get back to living their lives. We hope this blog post on endocarditis was helpful for those hoping to learn more about it. If you know any patients with endocarditis and receiving treatment through a PICC line, you can check out our fashionablePICC line coversthat help secure and protect your PICC line.
We’d love to hear what else you want to learn about as we’re always looking for more great blog post topics.
Reviewed by :
Gregory Weingart, MD, a practicing ER physician, andAssistant Professor at the Eastern Virginia Medical School