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Other Names:
Heart Valve Infection, Infective or Infectious Endocarditis, Sub-acute Bacterial Endocarditis
Endocarditis

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Definition

Endocarditis is an infection of the thin membrane (endocardium) that lines the inside of the heart chambers and heart valves. Mostly, people who develop endocarditis have diseased heart valves (mitral, tricuspid or aortic valve).

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Causes

  • No definitive causative organism can be detected.

  • Congenital Heart Disease

  • Weakened heart valves e.g. mitral valve stenosis or prolapse, aortic valve stenosis or insufficiency, tricuspid valve stenosis or insufficiency

  • Bacteria - may gain access to the heart valves through the blood stream either:
    • During a dental procedure like tooth extraction, filling of tooth cavity or surgical procedure involving the prostate, bladder, rectum or female pelvic organs. Rarely, bacteria can enter the heart directly during heart surgery or enter the bloodstream during childbirth.

    • Frequent bouts of streptococcal throat infection

    • Infection in other part of the body like cellulitis, gum disease, inflammatory bowel disease or sexually transmitted disease.

    • Rheumatic fever

    • Contaminated needles and syringes that may be used by intravenous drug users.

    • Central venous catheter that may be inserted permanently to administer medication.

  • Viruses

  • Fungi

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Symptoms

  • Tiredness, weakness and headache.
  • Fever with chills.
  • Night sweats.
  • Muscle aches and joint pains.
  • Weight loss.
  • Heart murmur (may be new or a change may occur in the existing murmur).
  • Breathing difficulty especially with activity.
  • Swelling in your legs, feet or ankles.
  • Weight loss.
  • Loss of appetite.
  • Anemia (paleness)
  • Splinter hemorrhages under the nails.
  • Clubbing of fingers.
  • Retinal hemorrhages with a clear central spot.
  • Small pinpoint conjunctival hemorrhages.
  • Red and painful nodes in the pads of the fingers and toes.

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Implications

Endocarditis can completely and permanently damage the heart valves if not diagnosed and treated promptly. This can lead to right ventricular failure where the heart has to work harder to meet the body's demands for oxygen. This is a chronic condition where the right side of the heart (right ventricle) weakens, becomes enlarged and fails to do it's job. Clumps of bacteria and cellular debris (vegetations) may break loose and travel to the brain, kidneys, lungs, or abdomen, causing stroke or severe damage to these organs. Untreated endocarditis is a life threatening condition.

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What You Can Do

  • Hospitalization is required initially to administer intravenous antibiotics. The specific antibiotic is chosen after performing culture and sensitivity testing on the blood.

  • Long-term oral antibiotic therapy is recommended to completely eradicate the bacteria.

  • Nonsteroidal anti-inflammatory drugs like aspirin, tylenol or ibuprofen may be recommended for fever and joint pains.

  • Complete bed rest.

  • Eat a healthy and nutritious diet

  • Drink plenty of fluids to flush the kidneys and reduce the burden of antibiotics and pain killer

  • Prevention
    • People who are at high risk of developing endocarditis should take prophylactic antibiotics before undergoing any dental or surgical procedures.

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Endocarditis