Endocarditis

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Endocarditis
Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Fever, heart murmur, fatigue, night sweats, shortness of breath, chest pain
Complications	Heart failure, stroke, sepsis, glomerulonephritis
Onset	Gradual or sudden
Duration	Weeks to months
Types	N/A
Causes	Bacterial infection, fungal infection
Risks	Heart valve disease, congenital heart defect, intravenous drug use, prosthetic heart valve
Diagnosis	Blood culture, echocardiogram, CT scan, MRI
Differential diagnosis	Myocarditis, pericarditis, rheumatic fever
Prevention	N/A
Treatment	Antibiotics, surgery
Medication	Penicillin, vancomycin, gentamicin
Prognosis	Variable, depends on cause and treatment
Frequency	3 to 10 per 100,000 people per year
Deaths	20% to 25% mortality rate

Histopathology of vegetation of bacterial endocarditis

Endocarditis is an inflammatory pathology that predominantly impacts the endocardium, the inner lining of the heart. Though primarily stemming from bacterial sources, various other microorganisms or non-infectious triggers can induce this condition. Predominantly, heart valves become the focal point of this ailment, with a potential escalation to critical complications if not addressed in due time.

Etiology and Predisposing Factors

Endocarditis can manifest from a myriad of microorganisms; however, bacteria such as streptococci, staphylococci, and enterococci are the most frequent culprits. A subtype, termed non-infective endocarditis, arises without concurrent infection, influenced by factors like lupus, cancer, or specific drug usage. Predisposing factors include the presence of prosthetic heart valves, prior endocarditis episodes, congenital heart anomalies, and intravenous drug utilization.

Clinical Manifestations and Potential Complications

Clinical manifestations span a spectrum from fever, fatigue, weight loss, night sweats, to the auditory sign of a heart murmur. As the pathology advances, graver signs such as heart failure might surface. Complications encompass heart valve deterioration, heart failure, cerebral events like stroke, and systemic embolism.

Diagnostic Approach and Therapeutic Interventions

For diagnosis, clinicians commonly resort to blood cultures to identify causative agents and employ imaging modalities like echocardiography for detailed visualization of heart valves. A well-established set of criteria, the Duke Criteria, amalgamates clinical, laboratory, and echocardiographic data for a conclusive diagnosis. Treatment paradigms primarily involve prolonged antibiotic regimens, often necessitating in-patient care. In scenarios where antibiotics fail or the disease severity escalates, surgical interventions to repair or supplant damaged heart valves might be imperative.

Prophylaxis

To thwart the onset of endocarditis, it is advisable to maintain dental hygiene and undergo periodic dental examinations since dental infections can be a precursor to endocarditis. Certain high-risk cohorts might also necessitate antibiotic prophylaxis prior to specific dental or surgical ventures.

Related Topics

• Carditis
• Myocarditis
• Pericarditis

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