Endocarditis

Endocarditis is an infection or inflammation of the endocardium—the inner lining of the heart's chambers and valves. The condition is most often caused by bacteria entering the bloodstream and attaching to damaged areas of the heart. It can lead to severe complications if not treated promptly, including heart valve damage, stroke, or even death.

Though rare, endocarditis remains a serious medical concern requiring early diagnosis and appropriate treatment. Individuals with existing heart conditions, artificial heart valves, or a history of endocarditis are at greater risk. Understanding the disease is crucial for timely intervention and effective management.

Endocarditis is a serious condition characterised by the inflammation of the endocardium. It usually results from an infection caused by bacteria, fungi, or other microorganisms that enter the bloodstream and adhere to the heart's inner surfaces. Once established, the infection can form clumps known as vegetations, which can interfere with normal heart function and cause systemic complications.

It may develop suddenly (acute endocarditis) or slowly over time (subacute or chronic endocarditis), depending on the underlying cause and the individual’s health.

India

In India, the exact prevalence of endocarditis is under-reported, but estimates suggest 4 to 7 cases per 100,000 people annually. It is more common in patients with congenital heart disease, rheumatic heart disease, or prosthetic heart valves.

Worldwide

Globally, the incidence of infective endocarditis ranges from 3 to 10 cases per 100,000 people per year. Developed countries report higher rates due to better detection methods and longer life expectancies of patients with cardiac devices.

• Infective Endocarditis: Caused by bacterial, fungal, or other microbial infections.
• Non-infective (Nonbacterial) Endocarditis: Usually associated with autoimmune disorders or cancers. Includes Libman-Sacks endocarditis seen in lupus.
• Acute Endocarditis: Rapid onset with severe symptoms, typically caused by virulent organisms like Staphylococcus aureus.
• Subacute Endocarditis: Slower progression, often caused by less aggressive bacteria such as Streptococcus viridans.

• Bacterial Infections: Most commonly Streptococcus and Staphylococcus species.
• Fungal Infections: Candida and Aspergillus in immunocompromised individuals.
• Intravenous Drug Use: Introduces bacteria directly into the bloodstream.
• Dental Procedures: Poor oral hygiene or dental surgeries can lead to bacteraemia.
• Indwelling Catheters or Heart Devices: Increase risk by allowing pathogens to enter the body.
• Autoimmune Conditions: Can lead to sterile vegetations on valves.

• Fever and Chills
• Fatigue and Weakness
• Night Sweats
• Heart Murmurs
• Shortness of Breath
• Swelling in Legs or Abdomen
• Petechiae (tiny purple or red spots on the skin)
• Osler’s Nodes and Janeway Lesions (painful or painless spots on fingers and toes)

The symptoms can be nonspecific, especially in subacute cases, which complicates diagnosis.

• Blood Cultures: To identify the causative microorganism.
• Echocardiogram (TTE or TEE): Detects vegetations or damage to heart valves.
• Electrocardiogram (ECG): May show rhythm abnormalities.
• Complete Blood Count (CBC): Indicates infection.
• Chest X-ray and CT Scan: Used to detect complications like pulmonary embolism or abscesses.

Modified Duke Criteria are widely used for clinical diagnosis.

Medications

• Antibiotics: The primary treatment; usually administered intravenously for 4–6 weeks. Common antibiotics include penicillin, ceftriaxone, vancomycin, and gentamicin. (Pencip 400000IU Tablet)
• Antifungal Agents: For fungal endocarditis, medications like amphotericin B or fluconazole are used. (Flukem 150mg Tablet)
• Supportive Therapy: Includes antipyretics, fluids, and nutritional support. (A to Z Gold Capsule)

Surgical Treatment

• Valve Repair or Replacement: Recommended when there is severe valve dysfunction, persistent infection, or embolic events.
• Device Removal: Required if infected cardiac devices are involved.

Alternative treatments do not replace conventional therapies but may include:

• Herbal Supplements: Garlic or turmeric may have mild anti-inflammatory properties, though not proven to treat endocarditis.
• Nutritional Support: A balanced diet supports immune function and recovery.

Always consult your healthcare provider before trying alternative treatments.

• Pre-existing Heart Conditions: Especially valve disorders and congenital defects.
• Prosthetic Heart Valves: Artificial valves are more susceptible to infection.
• History of Endocarditis
• Intravenous Drug Use
• Chronic Diseases: Such as diabetes or cancer.
• Immunosuppression: HIV, chemotherapy, or steroids increase risk.

• Heart Valve Damage: Leading to heart failure.
• Stroke: From emboli breaking off vegetations.
• Sepsis: Life-threatening systemic infection.
• Abscesses: In the heart or other organs.
• Kidney Damage: From immune complex deposition.

• Complete Your Antibiotic Course: To fully eradicate the infection.
• Follow-Up Regularly: Monitor heart function and check for complications.
• Maintain Good Hygiene
• Eat Nutritious Foods: Boosts immunity and supports recovery.
• Stay Physically Active: As tolerated, to regain strength.

• "It’s a common illness": It's rare but dangerous.
• "Only drug users get it": It can affect anyone, especially those with heart issues.
• "Antibiotics always cure it": Some cases need surgery.
• "You can't get it again": Recurrence is possible.

• Persistent fever or fatigue
• Shortness of breath
• New or changing heart murmurs
• Skin rashes or unusual spots

• What type of endocarditis do I have?
• What is the best treatment plan?
• Do I need surgery?
• How long will treatment last?
• What are the chances of recurrence?
• Are there any lifestyle changes I should adopt?

• Be Informed: Understand their treatment plan.
• Offer Practical Help: Like driving to appointments or preparing meals.
• Provide Emotional Support: Recovery can be isolating and exhausting.
• Watch for Symptoms: Encourage prompt medical attention if symptoms return.

Endocarditis is a severe but manageable condition when diagnosed early and treated properly. With modern medical advances, most patients recover well. Education, early detection, strict adherence to treatment, and lifestyle adjustments can help prevent recurrence and improve outcomes.