health

1. Definition .
   
2. What Is Endocarditis?
3. What Causes Infectious Endocarditis?
4. Who Gets Infectious Endocarditis?
5. What Are the Signs and Symptoms of Infectious Endocarditis?
6. How Do Doctors Diagnose and Treat Infectious Endocarditis?
7. Do People Recover from Infectious Endocarditis?
8. How Is Infectious Endocarditis Prevented?

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Infectious endocarditis (in-FEK-shus en-do-kar-DYE-tis) is an inflammation
of the valves and internal lining of the chambers of the heart,
known as the endocardium (en-doh-KAR-dee-um), that is initiated by an
infection.

The heart has four chambers and four valves that regulate the flow of blood
through the heart. Each valve is made up of two or three smaller parts,
known as leaflets, that swing open and shut. As the heart beats, it pumps
blood through the chambers and out of the heart to the lungs and the rest
of the body. The valves open to allow blood to pass through and out of
the heart and then close to keep the blood from flowing backward.
In a normal heart, the swift, smooth movement of blood sweeps foreign
material such as bacteria away from the heart. However, some people have
defects in their heart valves, the endocardium, or other parts of the heart that
disrupt the flow of blood. This disruption can allow bacteria or other germs
that reach the heart through the bloodstream to lodge there and multiply,
which results in an infection that inflames the heart valves, muscles, and
endocardium, producing endocarditis. The inflammation (in-flah-MAYshun),
which is the body’s response to injury or infection, can be significant,
in which case it may inflict damage on or even destroy the heart valves.

Viruses, fungi, or other microscopic organisms can all cause infectious
endocarditis, but the disease usually arises from a bacterial infection.
A common bacterium abundant in the oral cavity, Streptococcus viridans
(strep-tuh-KAH-kus VEER-ih-danz), is responsible for up to half of all
cases of bacterial endocarditis. Other bacterial culprits include bacteria
from the staphylococcus, streptococcus, and enterococcus families and,
less commonly, other types.
In most cases of infectious endocarditis, bacteria that normally live harmlessly
on the body, such as in the mouth, on the skin, in the intestines, or in
the urinary tract (YOOR-ih-nair-e TRAKT), enter the blood (a condition
known as bacteremia, bak-tuh-REE-me-uh). The bacteria can enter tissues
through a cut or a tear that has resulted from a dental or medical procedure,
or they may enter the blood because of a site of an infection somewhere else
in the body. Additionally, intravenous drug users are at high risk for infectious
endocarditis, as staphylococcus bacteria in skin have many opportunities
to enter the bloodstream through broken skin. Once in the bloodstream,
the bacteria travel to the heart and may stick to the endocardium or heart
valves. As they grow and multiply, the bacteria may become entangled in
vegetations, which are composed of clumps of platelets; bacteria; red and
white blood cells; and fibrin, a protein that helps blood clot.

Infectious endocarditis is not contagious, so there is no reason to avoid contact
with individuals who have it. The disease is not common among people
with normal hearts, but people with a heart abnormality are more susceptible
to it. Because bacteria can easily attach to a malformed or damaged
part of the heart, people with an artificial or damaged heart valve or a heart
defect are more likely to get endocarditis. Anyone who has had infectious
endocarditis or who has an indwelling catheter has a greater chance of
becoming infected. Although many people with heart defects are born with
them, other people acquire the defects during their lifetime, for example, as a
consequence of intravenous drug use or rheumatic fever, which puts them
at increased risk for endocarditis as well. In the United States between 1 and
4 cases of infectious endocarditis occur annually per 100,000 people.

Flulike symptoms, such as fever and chills and weakness, are the most common
symptoms of infectious endocarditis. Some people experience weight
loss, weakness, headache, tiredness, shortness of breath, joint and muscle
pain, and excessive sweating at night (night sweats). A heart murmur usually
develops in the course of the illness, and individuals may look pale, have red
spots on their skin, and see blood in their urine. An enlarged spleen; small
hemorrhages in the nail beds and on the whites of the eyes; and swelling of
the feet, legs, and abdomen also can occur with infectious endocarditis.

Doctors may suspect infectious endocarditis if someone with a known
heart abnormality develops an unexplained long-lasting fever, an abnormal
heart sound (a murmur), or symptoms of heart failure such as shortness
of breath or swelling of the legs.
Certain tests can help doctors to diagnose infectious endocarditis,
including blood cultures that can establish the presence of bacteria in
the bloodstream, a complete blood count, and laboratory tests that look
for evidence of inflammation. For example, checking a patient’s erythrocyte
sedimentation rate (ESR) reveals how quickly the person’s red blood
cells, or erythrocytes (eh-RITH-ruh-sites), settle to the bottom of a test
tube, which is a measure of inflammation in the body. Another blood test
identifies levels of C-reactive protein, which are increased in the blood
when there is significant inflammation in the body. Doctors may also use
an echocardiogram to look for signs of infection on the heart valves or in
the heart. An echocardiogram (eh-ko-KAR-dee-uh-gram) is a diagnostic
test that uses inaudible sound waves to produce images of the heart’s
chambers and valves and enables visualization of blood flow through the
heart.
Doctors treat infectious endocarditis with antibiotics. The medication
is given intravenously in the hospital at first, but sometimes patients complete
the treatment at home. Several weeks of antibiotic treatment may be
necessary to eliminate the infection. In more serious cases, patients may
need oxygen and medications to support heart function while hospitalized,
and some people require surgery to repair damage sustained by the
heart due to the inflammation.

Infectious endocarditis can start suddenly or develop gradually over weeks
or months. Left untreated, infectious endocarditis is often fatal. However,
when treated successfully with antibiotics and when there has been little
damage to the heart valves, patients usually begin to feel better and to
recover within a few days. If the infection does not improve with antibiotics,
or if there is evidence that a heart valve has been damaged significantly,
surgery to repair or replace the valve may be required to clear the
infection from the body and restore heart function.
Infectious endocarditis can cause other complications. In some
people with the disease, small pieces of vegetations in the heart may
break off and travel through the bloodstream to other organs. If one
of these pieces travels to the brain and blocks a blood vessel there, for
example, the affected person may develop a stroke. If the pieces lodge
in other organs, they may cause serious infections there. Infectious
endocarditis that is allowed to progress can also engender an irregular
heartbeat, congestive heart failure, jaundice, kidney failure, and heart
failure.

Doctors give antibiotics to people as a protective measure, prior to their
undergoing dental or medical procedures that could introduce bacteria
into the bloodstream. For example, simple dental work, removal of the
tonsils, or medical procedures in which parts of the upper respiratory tract
(such as the mouth and throat), urinary tract (specifically the urethra),
or lower gastrointestinal tract are involved can all provide an avenue for
bacteria to enter the bloodstream and travel to the heart.