Is Endocarditis Life Threatening?
The answer is yes, endocarditis is a life threatening disease. Endocarditis is the inflammation of the mural endocardium, which is the innermost layer of the heart. Typically in this disease cardiac valves are affected, but it may also involve the septum and endocardium structures and often associated to destruction of tissue involved.
What Causes Endocarditis Disease?
The condition most commonly arises due to bacterial infections (infective endocarditis) that migrate from structures neighboring to the heart or other organs via bloodstream or through foreign bodies, but some other physiological factors may also result in the development of the disease as seen in non-infective endocarditis. The main pathology behind the disease is formation of vegetation on previously damaged valve as seen in rheumatic heart disease or direct damage to cardiac tissue. This comprise of the thrombotic debris and the causative micro-organisms, which usually belong to Staphylococcus and Streptococcus bacterial group. In some cases, infections by fungus have also been registered. Staphylococcus is highly virulent and it produces destructive and necrotizing lesions rapidly.
Types of Endocarditis
Broadly the disease can be classified into Acute Endocarditis and Sub-Acute Endocarditis. In acute form infections are difficult to cure by prescribing antibiotics alone, thus require surgical intervention. Severity is so much high and disease progress so quickly that despite treatment, the patient may die within few days or weeks. In contrast to acute endocarditis, sub-acute endocarditis is a chronic disease which develops slowly and by severity is less destructive. In such patients, disease pursues protracted course ranging from weeks to months. Better compliance is observed and the patients can be treated with antibiotics only to achieve cure.
Similar condition arises when there is development of sterile vegetation on or around non-infected valves in patients with hypercoagulopathy. As they are caused by thrombus, hence called non-bacterial thrombotic endocarditis.
Less commonly, endocarditis may also occur by a pre-existing disorder like systemic lupus erythematosus (SLE). Such conditions are named as Libman Sacks endocarditis or sterile verrucous endocarditis.
Intravenous drug abuse may also open a direct entry point for virulent organisms into the circulation finally reaching heart and causing infection of the internal structures.
Clinical Features
Acute endocarditis usually has a stormy onset with early symptoms resembling flu. These include rapid fever, chills, lassitude and weakness. Generally, fever is consistent, but it may be present in slight form or may not be present at all especially in older individuals. Other symptoms include loss of weight due to bad appetite, nausea, dry cough and mild to moderate body aches usually in the chest, dyspnea (difficulty in breathing), night sweats and hematuria (blood in urine).
Heart Murmurs: Heart murmurs are a prominent finding in 90% patients of endocarditis of left side.
Petechiae: Petechiae (bleeding into the skin over small areas) and clubbing are also seen.
Other Symptoms: Peripheral manifestations like Osler’s Nodes (pulping of digits), Roth’s spots (retinal hemorrhage of the eye), Janeway Lesions (hemorrhagic or erythematous non-tender lesions on palm or the soles) and subungual hemorrhages may also be present.
Risk Factors
- Previous history of the endocarditis.
- Artificial or prosthetic valve implantation.
- Congenital heart diseases.
- Complete heart transplant (post-operative cardiac valvulopathy).
- Intravenous drug abuse.
- Valvular stenosis.
Management of the Disease
Whether the condition is treated with medication or surgery or both, there is requirement of certain investigations and procedures to confirm the condition, observing the development of the vegetation and to check the effect of medication on the body.
Investigations
Some commonly ordered investigations are-
- Echocardiography
- Angiography
- CBC (Complete Blood Count)
- Serum chemistry panel
- Blood sugar
- Urine analysis
- Blood culture.
Some other investigations may also be required if need arises. They are-
- Rheumatoid factor
- ESR (Erythrocyte sedimentation rate)
- CT Scan (Computed Tomography)
- MRI (Magnetic Resonance Imaging).
Treatment for Endocarditis
Patient is required to be treated according to causative factor.
Antibiotics
Cephalosporins – It is used to cease the growth or to kill bacteria.
Penicillin Derived – To cease the growth or to kill certain stains and specific types of bacteria.
Amphotericin B – It is given in case of fungal infections.
Surgical treatment requires valve replacement.
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