ENDOCARDITIS is the internal inflammation of the endocardium. and some value or has affected causes of this infection and noninfective endocarditis, management of the valve replacement medical management is antibiotic.
2. INTRODUCTION
Infective endocarditis is a rare disease, with an incidence of two to six
episodes per 100,000 habitants/year. Incidence is higher in elderly
people; besides, this group is often affected by many comorbidities.
3. DEFINITION
Endocarditis is an inflammation of the inner layer of the heart ,
the endocardium. It usually involves the heart valves, Other
structures that may be involved include the interventricular
septum , the chordae tendineae, the mural endocardium, or the
surfaces of intracardiac devices.
4. TYPES
Infective endocarditis, also called bacterial endocarditis, is an
infection caused by bacteria that enter the bloodstream and
settle in the heart lining, a heart valve or a blood vessel. The
cause is typically abacterial infection and less commonly a
fungal infection Risk factors include valvular heart
disease including rheumatic disease, rheumatic disease
,congenital heart disease ,artificial valves , hemodialysis ,
intravenous drug use, and electronic pacemakers. The bacterial
most commonly involved are streptococci.
Noninfective endocarditis refers to formation of sterile platelet
and fibrin thrombi on cardiac valves and adjacent endocardium
in response to trauma, circulating immune complexes,
vasculitis, or a hypercoagulable state.
5. CAUSES
Endocarditis can involve the heart muscle, heart valves, or lining of the heart. Some people who develop
endocarditis have a:
•Birth defect of the heart
•Damaged or abnormal heart valve
•History of endocarditis
•New heart valve after surgery
•Parenteral (intravenous) drug addiction
•Long-term intravenous line in place
Endocarditis begins when germs enter the bloodstream and then travel to the heart.
•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 during:
•Central venous access lines
•Injection drug use, from the use of unclean (unsterile) needles
•Recent dental surgery
•Other surgeries or minor procedures to the breathing tract, urinary tract, infected skin, or bones and muscles
6. RISK FACTOR
•Older age. Endocarditis occurs most often in older adults over age 60.
•Artificial heart valves. Germs are more likely to attach to an artificial (prosthetic) heart valve than to
a normal heart valve.
•Damaged heart valves. Certain medical conditions, such as rheumatic fever or infection, can
damage or scar one or more of your heart valves, increasing the risk of infection.
•Congenital heart defects. If you were born with certain types of heart defects, such as an irregular
heart or abnormal heart valves, your heart may be more susceptible to infection.
•Implanted heart device. Bacteria can attach to an implanted device, such as a pacemaker, causing
an infection of the heart's lining.
•A history of endocarditis. Endocarditis can damage heart tissue and valves, increasing the risk of
a future heart infection.
•A history of illegal IV drug use. People who use illegal drugs by injecting them are at a greater risk
of endocarditis. The needles used to inject drugs can be contaminated with the bacteria that can
cause endocarditis.
•Poor dental health. A healthy mouth and healthy gums are essential for good health. If you don't
brush and floss regularly, bacteria can grow inside your mouth and may enter your bloodstream
through a cut on your gums.
•Long-term catheter use. Having a catheter in place for a long period of time (indwelling catheter)
increases your risk of endocarditis.
8. SIGNS AND SYMPTOMS
Common signs and symptoms of endocarditis include:
•Aching joints and muscles
•Chest pain when you breathe
•Fatigue
•Flu-like symptoms, such as fever and chills
•Night sweats
•Shortness of breath
•Swelling in your feet, legs or abdomen
•A new or changed heart murmur, which is the heart sound made by blood rushing through your heart
Less common signs and symptoms of endocarditis can include:
•Unexplained weight loss
•Blood in your urine, which you might be able to see or that your doctor might see when he or she views
your urine under a microscope
•Tenderness in your spleen, which is an infection-fighting organ located just below your left rib cage
•Red spots on the soles of your feet or the palms of your hands (Janeway lesions)
•Red, tender spots under the skin of your fingers or toes (Osler's nodes)
•Tiny purple or red spots, called petechiae (puh-TEE-kee-ee), on the skin, in the whites of your eyes or
inside your mouth
9. DIAGNOSTIC EVALUATION
•Blood culture test. A blood culture test is used to identify any germs in your bloodstream. Blood culture test results help your
doctor choose the most appropriate antibiotic or combination of antibiotics.
•Complete blood count. This blood test can tell your doctor if you have a lot of white blood cells, which can be a sign of infection. A
complete blood count can also help diagnose low levels of healthy red blood cells (anemia), which can be a sign of endocarditis.
Other blood tests also may be done to help your doctor determine the diagnosis.
•Echocardiogram. An echocardiogram uses sound waves to produce images of your heart while it's beating. This test shows how
your heart's chambers and valves are pumping blood through your heart. Your doctor may use two different types of
echocardiograms to help diagnose endocarditis.
In a transthoracic echocardiogram, sound waves directed at your heart from a wand like device (transducer) held on your chest
produce video images of your heart in motion. This test lets your doctor see the heart's structure and check it for any signs of
damage.
A transesophageal echocardiogram gives your doctor a closer look at your heart valves. During this test, a small transducer
attached to the end of a tube is inserted down the tube leading from your mouth to your stomach (esophagus). This test provides
much more detailed pictures of your heart than is possible with a transthoracic echocardiogram.
•Electrocardiogram (ECG or EKG). An ECG is used to measure the timing and duration of your heartbeats. It isn't specifically used
to diagnose endocarditis, but it can show your doctor if something is affecting your heart's electrical activity. During an ECG, sensors
that can detect your heart's electrical activity are attached to your chest, arms and legs.
•Chest X-ray. A chest X-ray can show your doctor the condition of your lungs and heart. It can help determine if endocarditis has
caused heart swelling or if any infection has spread to your lungs.
•Computerized tomography (CT) scan or magnetic resonance imaging (MRI). You may need a CT scan or an MRI scan of your
brain, chest or other parts of your body if your doctor thinks that infection has spread to these areas.
10. MANAGEMENT
IV antibiotics for 6 weeks(PENNICILLIEN)
SURGERY
Heart valve surgery may be needed to treat persistent endocarditis infections or to replace
a damaged valve. Surgery is also sometimes needed to treat endocarditis that's caused by
a fungal infection.
Depending on your condition, your doctor may recommend repairing your damaged valve
or replacing it with an artificial valve made of cow, pig or human heart tissue (biological
tissue valve) or man-made materials (prosthetic mechanical valve).
PREVENTION
•Tell your doctors and dentists you have heart disease that places you at greater risk of developing
endocarditis.
•Take antibiotics before the following procedures (as recommended by the American Heart
Association):
• All dental procedures that involve manipulation of gingival tissue or the periapical region of teeth, or
perforation of the oral mucosa.
• Procedures of the respiratory tract or infected skin, tissues just under the skin, or musculoskeletal tissue
