Endocarditis is an infection of the thin layer of tissue that lines the inside of the heart chambers and valves, called the endocardium. It is caused by the introduction of bacteria or fungus into a damaged portion of this layer of tissue. Though relatively rare among folks with healthy hearts, it is more common among folks with some form of preexisting heart injury. Delay in diagnosing endocarditis can lead to serious injury including stroke, seizures, valve collapse, and even death.
Risk factors for endocarditis include artificial valves or previously damaged heart valves, heart defects – especially malformed heart valves, and a history of IV drug use. The infection gains access to the endocardium via the patient’s bloodstream. Bacteria or fungi may enter the bloodstream through any number of infections, or even from some of our own naturally occurring bacteria like that in our gut. IV drug use is a risk factor where unsanitized needles are being used. Again: directly introducing bacteria into the blood stream.
Clinicians should have endocarditis on their differential when the patient presents with a new or changed heart murmur, fever and/or chills, joint and muscle pain, chest pain when breathing in, and swelling in your hands, feet, or legs. Additional symptoms may include tenderness around your spleen, and hematuria (blood in urine), or red or purple spots on your skin. Of course, the symptoms vary from patient to patient.
Your provider would diagnose endocarditis through the strength of a detailed history, identification of symptoms, blood tests, a chest X-ray, and an echocardiogram. Treatment would typically begin with antibiotics or anti-fungals, depending on the type of infection. Timing is important, because if not treated quickly enough, the infection may form vegetations – clumps of cells and bacteria – at the site of infection. These clumps may break off and flow downstream and cause pulmonary emboli or strokes. They could also seed infections in other parts of the body. Infections on the valves may cause damage to the valve tissue itself and prevent it from properly opening and closing.
Again, prompt response to the symptoms should prevent serious injury, and avoid dramatic interventions like surgery, lengthy hospital stays, permanent heart damage, or death.
