Endocarditis (heart infection): symptoms, causes, and treatment

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Definition of endocarditis

What is endocarditis?

Endocarditis is an infection that attacks the endocardium, the inner lining of the heart chambers and heart valves. This lining of the heart functions to collect blood, pump, and regulate muscle cells to react to stimuli.

According to the National Heart, Lung, and Blood Institute endocarditis is one of three types of inflammation of the heart, apart from myocarditis and pericarditis.

This infection of the heart can be caused by bacteria, fungi, parasites, or other germs that start from the mouth, spread to the blood, and eventually reach the heart area.

This bacterial heart infection is also known as infective endocarditis. Sometimes some health professionals call it bacterial endocarditis. Not only in the endocardium, but infection can also lead to the valves and heart muscle.

However, in some cases, the doctor may not be able to find the exact cause because of the many factors and factors that cause infection of the heart.

If not treated promptly, the infection gets worse and can lead to complications, such as arrhythmias or irregular heartbeats and heart failure. Therefore, the doctor's care should be taken as soon as the patient complains of symptoms.

How common is this disease?

Endocarditis is a heart disease that can affect anyone. However, this disease is generally susceptible to attacking people with congenital heart defects, has damaged heart valves, and uses artificial heart valves.

Signs & symptoms of endocarditis

The symptoms of endocarditis can appear suddenly and be severe or mild. This will depend on what germs caused the infection and heart problems you previously had.

Common signs and symptoms of endocarditis are:

• Experiencing flu-like symptoms, such as fever, chills, and chills.
• Body fatigue accompanied by joint pain and muscle aches (myalgia).
• Shortness of breath and chest pain.
• Swelling of the ankles and hands.
• The body sweats at night.
• A heart sound is heard because blood is rushing to the heart.

In some cases, endocarditis can also cause other symptoms, such as:

• Body weight continues to decrease for no apparent reason.
• There is blood in the urine, this can be seen directly or needs to be seen by a doctor through a microscope examination.
• Red spots appear on the soles of the feet or palms (Janeway lesions), red, tender spots under the skin of the fingers or toes (Osler's nodes), or red-purple spots on the skin, whites of the eyes, and inside the mouth (Petechiae).
• The left side of the body near the ribs becomes more sensitive.

Each person can experience different symptoms and intensity. Some people may also experience other symptoms that were not stated.

When to see a doctor?

If you experience signs and symptoms of endocarditis, seek medical attention immediately. Especially if you have fever, shortness of breath, and chest pain.

You may suspect a heart infection because it causes common symptoms of heart disease, such as shortness of breath and chest pain, along with fever. Fever is a sign that the immune system is fighting an infection.

Before giving treatment, the doctor will look at risk factors for existing heart infections and ask you to do a series of tests.

Causes of endocarditis

The main cause of endocarditis is infection from germs, such as bacteria, fungi, or parasites. The most common cause of infection is bacteria. While the most rare cause is fungus. Even so, yeast infections are generally much more severe and dangerous.

This infection starts in another area of ​​the body that enters the bloodstream and travels to the heart. These germs tend to stick to the rough surface of the heart's lining, for example in people with heart problems or inflammation.

The germs that stick together eventually cause heart infections. Even so, infection can also affect people with heart-healthy conditions.

The body is supposed to command the immune system to destroy germs. The germs will die, flow with the blood, and pass through the heart without causing any problems.

However, some stubborn germs stay alive, flow into the blood, and cause infection in the heart. The germs that tend to cause these infections generally live in the mouth, throat, or skin and intestines.

Various possible germs get into the blood

Reporting from the Mayo Clinic website, germs can enter the bloodstream and cause endocarditis in various ways, including:

• Teeth and mouth conditions

Brushing your teeth, which often causes bleeding gums and sores or has dental problems because you rarely brush your teeth or use dental floss.

• Infections or other medical conditions

Infections do not only come from the mouth, but also from other parts of the body, such as sexually transmitted infections or inflammation of the intestine which allows bacteria to enter the blood and reach the heart.

• Long-term use of a catheter

Bacteria can enter your body through a catheter, which is a thin tube your doctor uses to inject or remove fluid from your body.

• Use of a syringe

The use of syringes can bring bacteria into the body, especially those in non-sterile conditions, such as tattoo needles, body piercing needles, and needles for illegal drugs.

• Certain dental procedures

Dental medical procedures that affect the gums allow bacteria to enter the bloodstream.

Risk factors for endocarditis

In people with a healthy heart, the risk of endocarditis is still there, although it is small. The risk is very high if the person has a rough endocardium surface. This is because germs can easily stick and multiply in the area.

People who are at high risk of developing this heart infection are:

• People who have artificial (prosthetic) heart valves because their heart valves are damaged or don't work properly.
• People are born with congenital heart disease, which makes them especially susceptible to infections.
• Have had endocarditis before and have the possibility of recurrence at a later date.
• People who have severe rheumatic fever. This condition can damage the valve and make it easier for infection to occur in that area of ​​the heart.
• People who use illegal drugs through needles are not sterile.

Endocarditis complications

When endocarditis occurs, clumps of bacteria and cell fragments can form in the infected area of ​​the heart.

These bacteria gather to form a colony, while cell fragments will accumulate. Both, can be separated and spread to other organs, such as the brain, lungs, stomach, or kidneys.

The spread of this infection occurs because the blood pumped by the heart circulates throughout the body, increasing the chance for bacteria to spread to other areas of the body and cause wider infection. This condition is known as a complication of heart infection.

Life-threatening complications of endocarditis include:

• Heart murmurs, more severe heart valve damage, and heart failure.
• Strokes and seizures.
• Loss of ability to move the body (paralyzed).
• An abscess (pus-filled lump) forms in the heart, brain, lungs, or other organs in the body.
• Kidney damage.
• The spleen is swollen and infected.

Diagnosis & treatment of endocarditis

The information provided is not a substitute for medical advice. ALWAYS consult your doctor.

In order to decide the right treatment for endocarditis, the doctor must need to make a diagnosis. From this diagnosis, the doctor will know what causes you to have an infection of the heart.

Various tests to diagnose endocarditis include:

Physical examination

The doctor will check for symptoms you are experiencing, such as fever and small bumps on the hands and feet. Then, the doctor will also listen to your heart rate from the stethoscope to see if you have a heart murmur or not.

Through this examination, the doctor will rule out other possible health problems to make it easier to get a diagnosis.

Blood test

The next health test that the doctor will recommend is a blood test. This examination is done to find out an infection, which includes:

• Blood culture test to check for bacteria or fungi that cause infection.
• The C-reactive protein test looks for an increase in liver protein that indicates inflammation.

Echocardiogram

An echocardiogram is a medical test that uses sound waves to scan the heart. These waves will later produce detailed images, heart muscle, chambers, and heart valves.

This examination is done to see the structure and function of the heart more clearly. As well as checking for bacterial clots or cell fragments that have formed and detecting which heart tissue is infected.

CT scan

A CT scan relies on X rays to take pictures of the inside of your body, where any pus (abscess) may have formed in your body.

What are the drug options for endocarditis?

After establishing the diagnosis and cause, the doctor will consider the appropriate treatment for heart infection. Ways to treat this heart infection include:

Taking medication

Based on the cause of the heart infection, the doctor will prescribe a more appropriate medication. The reason is, infections caused by bacteria must be treated with antibiotics.

According to the American Family Physician, to treat infective endocarditis, doctors will be prescribed the antibiotic vancomycin or ampicillin / sulbactam combined with aminoglycosides (plus rifampin in patients with artificial valves).

Aminoglycosides are a group of antibiotics that work by inhibiting bacterial protein synthesis. However, use of this drug is limited because of the potential for side effects as it can cause ear and kidney damage.

Examples of drugs that fall into the aminoglycoside class for endocarditis are:

• Tobi pro (tobramycin).
• Garamycin (gentamicin).
• Humatin pro (paromomycin).
• Amikin pro (amikacin).

If the bacteria are resistant to this type of antibiotic, the fluoroquinolone class of drugs is used in combination with vancomycin and rifampin. This antibiotic therapy is carried out for 2 to 6 weeks, depending on the severity of the condition.

These antibiotics can have side effects. If you experience any disturbing and worrisome side effects, consult your doctor.

Antibiotics cannot be used as a cure for heart infections caused by fungi. In this case, the doctor will prescribe an antifungal medication.

Surgical procedures

If the infection has damaged your heart valves and shows symptoms of complications, a surgical procedure is needed. This operation can be aimed at infections caused by bacteria or fungi.

The choice of medical procedures will be adjusted according to this condition, starting from heart valve repair and heart valve replacement.

Home remedies for endocarditis

Apart from doctor's treatment, you also need to make lifestyle changes according to your endocarditis. It is prioritized to take the medicine given by the doctor according to the recommendation and avoid the body from being injured.

In patients who also have other health problems, home remedies may include healthy food choices for the heart or kidneys, getting enough rest and sleep, and keeping yourself active but not overly active.

Endocarditis prevention

How can you prevent endocarditis?

Endocarditis is a disease that you can prevent. You do this by reducing various risk factors that make you susceptible to infection.

More specifically, endocarditis prevention measures that you can take are:

• Increase self-insight about this disease. If you are among those at risk, it is necessary to understand what the symptoms of this heart infection look like.
• Be diligent in maintaining oral hygiene, such as brushing your teeth 2 times a day in the morning after meals and at night before going to bed. Do this carefully to prevent sores in the mouth.
• Avoid various things that can infect the skin, such as body piercing or getting tattoos.
• Take the antibiotics prescribed by your doctor until they run out if you have an infection.
• Tell your dentist if you have a high risk of developing endocarditis during dental procedures.

If you have any questions, consult your doctor for the best solution to your problem.