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Infective Endocarditis

infective endocarditis

Infective endocarditis is an infection that affects some part of the endocardium. The endocardium is the tissue that lines the inside of the heart chambers. The infection usually involves one or more heart valves which are part of the endocardium. It is a serious infection that is life-threatening.

How does infective endocarditis occur and progress?

Most cases are caused by infection with bacteria. A small number of cases are caused by infection with fungi. To develop this infection, you need to have some bacteria or fungi in the bloodstream.

Most bacteria that get into the bloodstream are killed by the immune system. However, sometimes some bacteria survive and settle on a heart valve (particularly if the valve is already damaged in some way), or on another section of the endocardium. In time, small clumps of material called vegetations may develop on infected valves. The vegetations contain bacteria or fungi, small blood clots, and other debris from the infection.

Who gets infective endocarditis?

It can occur in anybody, but the risk of developing it is increased in people who have:

  • Heart valve problems or an artificial heart valve. Heart valves that are already damaged or abnormal are more likely to become infected.
  • Had surgery to a heart valve.
  • Certain congenital heart defects.
  • A heart condition called hypertrophic cardiomyopathy.
  • Had a previous episode of infective endocarditis.
  • Been injecting street drugs such as heroin, with dirty or contaminated needles.
  • A poor immune system - for example, people with AIDS.

What are the symptoms and signs of infective endocarditis?

Slowly developing infection

This is sometimes called subacute bacterial endocarditis (SBE). You tend to feel generally unwell and may have general aches and pains, tiredness, and be off your food. A fever (a high temperature) develops at some stage in most cases. Heart murmurs tend to develop.

Rapidly developing infection

In some cases the symptoms develop quite quickly and you can become very unwell over a few days.

What are the possible complications?

Complication in the heart

The infection can damage heart valves. This can lead to serious problems such as heart failure. In some cases, the infection spreads and can damage other parts of the heart. In some cases, an abscess (ball of pus) forms in the heart muscle nearby.

Complications in other parts of the body

Small bits may break off from the vegetations on the infected heart valves. These are called infected emboli and get carried in the bloodstream, and lodge in other parts of the body.

  • Small spots may appear under fingernails, in the eyes, or on other parts of the body.
  • Infections may develop in other parts of the body.
  • The spleen may enlarge, as it is the main organ that fights off blood infections.
  • If a larger chunk of vegetation breaks off then it can block the blood flow in a main artery.

What tests are needed?

You will be admitted to hospital if infective endocarditis is suspected. You will have several blood samples taken which are tested for bacteria and fungi. An ultrasound scan of the heart, called echocardiography, is the most useful test to confirm infective endocarditis.

What is the treatment for infective endocarditis?

Medication

As soon as the condition is suspected you will be given regular doses of antibiotics that are injected directly into a vein. Sometimes the types of antibiotics are changed once the results of the blood samples are back and the best antibiotics to use are found. The course of antibiotics is for at least 2-4 weeks, but it is often longer.

Surgery

An operation is needed in up to half of cases when the infection is more severe. Replacing a damaged valve with an artificial valve. Valve repair if the damage is less severe and repair is possible. Drainage of any abscesses (collections of pus) that may develop in the heart muscle or in other parts of the body.

What is the prognosis?

The outlook is good if the infection is diagnosed and treated early. Many people are cured with a course of antibiotics. However, serious damage to the heart occurs in some cases. Some people die from the complications.


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