endocarditis

Endocarditis: description

Endocarditis is one Inflammation of the heart, the so-called endocardium. The heart wall is made up of different layers – the endocardium is the innermost one. It covers the atria and ventricles of the heart and also forms the four heart valves. These act as valves for the blood that is pumped through the heart with every beat. In endocarditis, one or more heart valves are inflamed in most cases, usually the mitral valve and / or the aortic valve.

Of every 100,000 people, about three develop heart attacks each year, caused by bacteria or fungi. There are also non-infectious forms of endocarditis. Here, the endocardium ignites, without it being colonized by pathogens, for example in the context of rheumatic fever. The non-infectious form of endocarditis is becoming increasingly rare in Western countries, while the infectious form is becoming more prevalent. This is mainly because today certain heart surgeries are performed more often – and these can be the cause of an infection. As a result, more elderly people develop endocarditis than before. It is still a rare disease.

Infectious endocarditis distinguishes between two forms:

• In the acute course, the condition of the affected suddenly deteriorates rapidly.
• In the subacute form (endocarditis lenta), the signs appear creeping and are therefore often not directly recognized as endocarditis symptoms.

In both cases, it is important that heart attack be diagnosed and treated as early as possible to avoid severe events.

Endocarditis: symptoms

The symptoms of endocarditis vary according to their cause. In infectious endocarditis one roughly distinguishes two forms of progression:

The acute endocarditis is often triggered by staphylococci. It manifests itself with sudden and rapidly progressive symptoms:

• fever
• chills
• accelerated heartbeat (tachycardia)
• Muscle and joint pain
• Clouding of consciousness

The subacute form (Endocarditis lenta), on the other hand, begins gradually. Typical pathogens of subacute endocarditis are streptococci. Those affected often have mild fever and may have a variety of symptoms that are not as easily attributed to:

• weakness
• anorexia
• weight loss
• Muscle and joint pain
• punctate skin bleeding (petechiae)
• Skin nodules on fingers and toes (Osler nodules)
• Bleeding in the eye

In addition, the doctor can often detect altered heart sounds, enlargement of the spleen, and impaired kidney function.

Endocarditis symptoms may be slightly different for non-infectious causes. For example, rheumatic endocarditis usually focuses on other signs of rheumatic fever – such as joint pain that migrates from one joint to another. For a long time, people with lupus erythematosus often do not notice it when deposits form on their heart valves. However, other layers of the heart wall can also become inflamed (pericarditis, myocarditis) and cause various symptoms such as chest pain and an accelerated heartbeat.

Endocarditis: causes and risk factors

Endocarditis can have different causes. Both infectious (bacterial) endocarditis and non-infectious (abacterial) form is possible.

Trigger for one infective endocarditis are in most cases bacteria, especially staphylococci and streptococci, occasionally also enterococci. Other bacteria and fungi are also possible as causers, but rarely. Fungal infections account for about one percent of endocarditis.

Bacterial endocarditis is usually caused by small pre-lesions of the heart lining, on which the pathogens then settle, for example by:

• one congenital or acquired heart defect (e.g., open ductus arteriosus); unnatural blood turbulence can attack the endocardium and promote infection.
• Operations at the heartespecially when foreign bodies are used; this is especially true for artificial heart valves, but also venous catheters and cables of cardiac pacemakers.

Even if many bacteria are flushed into the bloodstream, endocarditis can be the result. This can happen, for example, in certain operations in the area of ​​the teeth and respiratory tract, as well as by an abscess or in drug addicts who use syringes.

However, endocarditis does not always have to be accompanied by a bacterial infection of the heart’s lining. Some illnesses can also be one non-infective endocarditis trigger:

The rheumatic endocarditis only arises as step two of a bacterial infection. About one to three weeks after a streptococcal infection (usually in the form of tonsillitis or pharyngitis), the so-called rheumatic fever may occur. The patient develops a high fever and it inflames alternating joints, sometimes nodules and rashes on the skin. The heart may also be involved, for example in the form of rheumatic endocarditis. Nonetheless, they are referred to as non-infective endocarditis, as these inflammations do not go back to the streptococci, but to defense mechanisms of the immune system, which also mistakenly attack the body’s own tissue.

Endocarditis may also occur as part of systemic lupus erythematosus, an autoimmune disease of the rheumatic type. This is called one Libman-Sacks endocarditis, Similar to the rheumatic endocarditis caused by the body’s defense inflammation and small deposits on the heart valves (fibrin thrombi).

Endocarditis is also rarely associated with Löffler syndrome, an inflammatory disease that usually affects the lung tissue. At a Loeffler endocarditis Thickening of the inner skin. On it certain defense cells (eosinophile granulocytes) accumulate.

Endocarditis: examinations and diagnosis

To diagnose endocarditis, the doctor first asks about the medical history (Anamnese). He asks, for example, if the patient has a heart defect and if there has been an intervention on the heart. But other operations (for example, at the dentist) can provide important information. This also applies to previous infections, autoimmune diseases and drug use. In the physical examination For example, doctors measure body temperature and listen to the heart with a stethoscope.

Suspected endocarditis is followed by one echocardiography, The heart is examined through the chest with an ultrasound machine. This is followed by further investigations if abnormalities are detectable or the person concerned has an increased endocarditis risk (for example, patients with artificial heart valves). Thus, a cardiac ultrasound conducted through the esophagus (transesophageal echocardiogram) provides a more accurate picture of the heart.

Also one blood test the patient can provide further information about the cause. The blood is tested in the laboratory for pathogens as possible triggers of infective endocarditis. If the cause of endocarditis remains unclear, further examinations follow, for example a magnetic resonance tomography (MRT) or the removal of a tissue sample of the endocardium (endocardial biopsy).

Endocarditis: treatment

Which endocarditis therapy is right for a particular case is decided by different specialists in consultation with one another – usually cardiologists, microbiologists and cardiac surgeons. In bacterial endocarditis, the most important action is fast and effective antibiotic therapy, for example with penicillin or vancomycin. As a rule, the antibiotics are administered intravenously (ie directly into the vein). The choice of the antibiotic vote the doctors as accurately as possible on the triggering pathogen.

For every second to third patient with infectious endocarditis, antibiotic therapy is insufficient. A surgery becomes necessary, for example, when the heart valves are severely damaged by the inflammation and a heart failure threatens. In that case, doctors typically remove the diseased tissue and insert one or more artificial heart valves into the patient.

For non-infectious causes, the most important part of endocarditis therapy is treating the underlying disease. For example, patients with systemic lupus erythematosus can help with cortisone preparations that slow down the autoimmune response. In rheumatic fever, on the one hand, the streptococci are combated with antibiotics, on the other hand, the defense reaction is attenuated with anti-inflammatory drugs.

Endocarditis: Prophylaxis

With which measures you can prevent endocarditis, you can find out here.

Endocarditis: disease course and prognosis

The prognosis of endocarditis depends on several factors:

• Time of diagnosis
• Cause of heart inflammation
• (Pre-) damage to the heart
• Age of the patient
• Immune system of the patient
• other diseases (for example diabetes mellitus)
• in bacterial endocarditis: sensitivity of the pathogen to antibiotics

Relatively frequent in endocarditis are complications that arise when growths or deposits on the endocardium dissolve. This can happen either by the pumping movement of the heart or even by a procedure with a catheter. If these “bits” are flushed into the bloodstream, they can clog a blood vessel and trigger a stroke or an embolism.

Today it can be an infectious endocarditis successfully treat in three out of four cases. However, if it is detected too late, or if the person is already older and has multiple illnesses, the likelihood that the endocarditis is fatal increases.