Endocarditis is a serious inflammatory condition that affects the heart valves and endocardium, obstructing blood flow and increasing the risk of heart failure and blood clots. It can be infectious or non-infectious and can lead to long-term heart damage and other serious complications if left untreated.

What is endocarditis?

Endocarditis is an inflammation of the heart valves or the inner lining of the heart (endocardium), which can cause serious health problems. Endocarditis affects the function of the heart, making it difficult for blood to flow normally and increasing the risk of heart failure and blood clots.

Endocarditis can be divided into two main categories:

1. Infective endocarditis – caused by infectious microorganisms such as bacteria, viruses or fungi that enter the bloodstream and cause inflammation in the heart valves. It is usually caused by bacteria that enter the body, such as through broken skin, the oral cavity, or medical procedures. This is the most common and serious type of endocarditis.
2. Non-infectious endocarditis – occurs due to non-infectious causes, such as autoimmune diseases, allergic reactions or side effects of certain drugs. In these cases, endocarditis develops as a result of an immune system reaction where the body attacks its own tissues, including the heart valves.

Endocarditis can lead to complications such as heart failure, the spread of infection to other organs, the formation of blood clots, and long-term damage to the heart valves.

Types of endocarditis

Endocarditis can be classified in several ways based on its causes, rate of development and heart valve changes. A detailed understanding of the types of endocarditis helps doctors make the correct diagnosis and appropriate treatment plan.

Bacterial endocarditis

Definition: bacterial endocarditis is an inflammation of the heart valves caused by a bacterial infection that threatens the heart's function and can lead to serious complications.

Causes: this disease is caused by bacteria such as Streptococcus viridans,Staphylococcus aureus and Enterococcus species that enter the heart valves through the bloodstream. The risk of infection increases in patients with damaged heart valves or those who have undergone invasive medical procedures.

Symptoms: Bacterial endocarditis often causes fever, chest pain, rapid heartbeat, dizziness, and fatigue. In more severe cases, difficulty breathing and circulatory disorders may also appear.

Fungal endocarditis

Definition: Fungal endocarditis is an inflammation of the heart valves caused by a fungal infection, most often in the heart valves, which seriously compromises heart function and can lead to life-threatening conditions.

Causes: usually caused by fungi from Candida or Aspergillus species that enter the bloodstream and settle on heart valves. The risk of this infection is higher in people with a weakened immune system, those who have undergone heart surgery or who use central venous catheters.

Symptoms: similar to bacterial endocarditis, but often more severe because fungal infections progress more slowly and are more difficult to treat. Symptoms may include fever, chills, night sweats, shortness of breath, chest pain and general malaise.

Nonfungal endocarditis

Definition: Nonfungal endocarditis is an inflammation of the heart valves caused by microorganisms other than bacteria or fungi, such as viruses or parasites.

Causes: This form of endocarditis can be caused by viruses or parasites that enter the bloodstream and affect the heart valves. In general, the risk is increased in people with a weakened immune system or a history of heart disease.

Symptoms: symptoms can vary depending on the severity of the inflammation and the specific pathogen, but are often similar to other types of endocarditis - fever, fatigue, chest pain and general malaise.

Immune endocarditis

Definition: immune endocarditis is an inflammation of the heart valves caused by an autoimmune reaction where the immune system mistakenly attacks heart tissue, especially the heart valves.

Causes: this condition is caused by autoimmune diseases such as systemic lupus erythematosus or rheumatoid arthritis, where the body's immune system begins to mistake heart tissue as foreign and attacks it, causing inflammation.

Symptoms: Symptoms are similar to other types of endocarditis and include chest pain, fever, fatigue, and shortness of breath. These symptoms may become more pronounced if the autoimmune reaction is intense.

Endocarditis of prosthetic heart valves

Definition: endocarditis of prosthetic heart valves is an inflammation of heart valves that develops on the surfaces of artificial (prosthetic) valves after their installation.

Causes: this endocarditis is usually caused by microorganisms, most often bacteria, that get on the surface of the valve, especially after surgery or invasive procedures. The risk of prosthetic valve endocarditis increases in cases of weakened immune system or chronic diseases.

Symptoms: Symptoms are similar to bacterial endocarditis, including fever, chest pain, fatigue, and dizziness. In addition, there is an increased risk of blood clots, as infection can promote the formation of clots on the surface of the valve.

Symptoms of endocarditis

Endocarditis can manifest itself with various symptoms, depending on the severity of the inflammation, the cause and the patient's general state of health. It is important to recognize the symptoms at an early stage to ensure fast and effective treatment.

Most common symptoms

Chest pain:

• Stinging, dry pain in the center or left side of the chest.
• The pain may radiate to the shoulders, neck or back.

Fever and dizziness:

• Increased body temperature, chills.
• Feeling like you might pass out.

Palpitations:

• Fast, irregular heartbeat or increased heart rate.

Shortness of breath:

• Difficulty doing physical activity or even at rest.

Fatigue and weakness:

• Reduced energy and stamina.

Chest pain or discomfort:

• Pressure, burning, or pain that may radiate to the neck, shoulder, or arm.

Swelling:

• Swelling of the abdomen or legs in severe cases.

More severe symptoms

Cardiac tamponade:

• Low blood pressure, weakness, dizziness.
• Rapid heartbeat and shortness of breath.
• Swelling of veins in the neck.

Constructive endocarditis:

• Pericardial thickening and scarring.
• The heart was unable to fill with blood effectively, causing severe symptoms of shortness of breath.

When to seek medical help

If the patient has any of these symptoms, especially chest pain or sudden shortness of breath, consult a doctor immediately. Early diagnosis and treatment are essential to prevent serious complications and improve the chances of recovery.

Diagnostic methods of endocarditis

Accurate diagnosis is essential to determine the cause, extent of endocarditis and to choose the most appropriate treatment plan. The diagnostic process includes history taking, physical examination, and various laboratory and imaging tests.

Medical history and physical examination

Medical history:

• Nature, duration and triggers of symptoms.
• Previous heart disease, heart valve problems.
• Family history of heart disease or arrhythmias.

Physical examination:

• Cardiac auscultation: pericardial rub murmur - a characteristic sound signal caused by disruption of the layers of the inflamed pericardium.
• Blood pressure and pulse measurement: variations in blood pressure and pulse rate.
• Check for fluid accumulation (edema): using clinical methods to determine fluid accumulation in the body.

Diagnostic tests

Electrocardiogram (ECG)

• Changes in the electrical activity of the heart.
• Typical ECG changes in endocarditis:

  • ST-segment elevation or ST-segment depression.
  • The T-bend – a challenge to cardiac muscle electrical activity.

Echocardiography

• An ultrasound examination that visualizes the heart and heart valve.
• Detects heart valve damage, pericardial effusion, and other structural abnormalities.
• Helps assess heart function and blood flow dynamics.

Chest X-ray

• Determines the size and shape of the heart.
• Reveals an enlarged cardiac shadow or other abnormalities that may indicate endocarditis or cardiac tamponade.

Chest computed tomography (CT) and magnetic resonance imaging (MRI)

• Detailed imaging for evaluation of heart and heart valve structures.
• Helps distinguish endocarditis from other heart diseases and determine the extent of inflammation.

Blood tests

Full blood count:

• Leukocyte count: an elevated white blood cell count may indicate an infection.
• C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR): elevated in inflammation.

Blood cultures:

• Examines the microorganisms that cause endocarditis, and certain types.

Troponins:

• May be elevated if myocardial damage is present.

Pericardial fluid analysis

Pericardiocentesis:

• A procedure in which fluid is removed from the heart valve cavity with a needle.
• Fluid analysis: investigates the causes of infection, the level of inflammation and other diagnostic information.

How to treat endocarditis?

Treatment aims to prevent the spread of infection, reduce inflammation, prevent damage to the heart valve and reduce the risk of complications. Treatment depends on the type, cause, and severity of endocarditis.

Antibiotic therapy

For bacterial endocarditis:

For fungal endocarditis:

Anti-inflammatory agents

• Nonsteroidal anti-inflammatory drugs (NSAIDs): reduces inflammation and pain.
• Colchicine: helps prevent relapses and reduces inflammation.

Surgical intervention

Heart valve repair or replacement:

• If heart valves are damaged, they can be repaired or replaced with prostheses.

Pericardiocentesis:

• Removal of fluid from the heart valve cavity to relieve symptoms and prevent cardiac tamponade.

Heart valve removal:

Supportive therapy

• Restriction of rest and physical activity: to reduce the workload on the heart and support recovery.
• Pain relief: the use of painkillers according to the doctor's instructions.
• Modulation of the immune system: if endocarditis is associated with an autoimmune disease, immune modulating therapy is required.

Endocarditis and lifestyle

Living with endocarditis

After endocarditis is diagnosed and treated, it is important to adjust your lifestyle to improve your chances of recovery and prevent recurrences.

Regular medical check-ups:

• Follow your doctor's instructions and have regular follow-up visits.

Physical activities:

• Avoid heavy physical exertion, especially during the first weeks of recovery.
• Gradual resumption of activities, after doctor's approval.

Healthy diet:

• A balanced diet rich in vitamins and minerals.
• Avoiding excessive salt intake to reduce fluid retention.

Hydration:

• Sufficient fluid intake, according to the doctor's instructions.

Quitting smoking and limiting alcohol consumption:

• Smoking and excessive alcohol consumption can worsen heart health and increase the risk of complications.

Psychological support

• Emotional support: talking to family, friends or support groups can help manage stress and anxiety levels.
• Psychological therapy: if necessary, consultations with a psychologist or psychiatrist.

Diagnostic methods of endocarditis

Accurate diagnosis is essential to determine the cause and severity of endocarditis and to choose the most appropriate treatment plan. The diagnostic process includes taking a medical history, physical examination, and several laboratory and imaging tests.

Medical history and physical examination

Medical history:

• Nature and duration of symptoms.
• Previous heart disease or surgery.
• Family history of heart disease.

Physical examination:

• Cardiac auscultation: endocardial friction murmur - a characteristic sound signal caused by disruption of the inflammatory endocardial layers.
• Measuring blood pressure and pulse.
• Test for fluid accumulation in the body (edema).

Diagnostic tests

Electrocardiogram (ECG)

• Changes in the electrical activity of the heart.
• Typical ECG changes in endocarditis:

  • ST segment changes: rise or fall.
  • T deflection: changes in the T wave shape.

Echocardiography

• An ultrasound examination that visualizes the heart and endocardium.
• Detects heart valve damage, pericardial effusion, and other structural abnormalities.
• Helps assess heart function and blood flow dynamics.

Chest X-ray

• Determines the size and shape of the heart.
• Reveals an enlarged cardiac shadow or other abnormalities that may indicate endocarditis or cardiac tamponade.

Chest computed tomography (CT) and magnetic resonance imaging (MRI)

• Detailed imaging for evaluation of heart and heart valve structures.
• Helps distinguish endocarditis from other heart diseases and determine the extent of inflammation.

Blood tests

Full blood count:

• Leukocyte count: an elevated white blood cell count may indicate an infection.
• C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR): elevated in inflammation.

Blood cultures:

• Examines the microorganisms that cause endocarditis, and certain types.

Troponins:

• May be elevated if myocardial damage is present.

Pericardial fluid analysis

Pericardiocentesis:

• A procedure in which fluid is removed from the heart valve cavity with a needle.
• Fluid analysis: investigates the causes of infection, the level of inflammation and other diagnostic information.

Prevention of endocarditis

Although it is not always possible to prevent endocarditis, there are ways to reduce the risk and promote heart health.

Infection prevention

Observance of hygiene:

• Thorough hand washing and contact with sick people.

Vaccination:

• Against flu, pneumococcus and other infectious diseases.

• In possible situations of risk of endocarditis, for example, before certain surgical procedures or dental treatment.

Healthy lifestyle

Strengthening the immune system:

• Healthy diet, enough sleep, regular physical activity.

Smoking cessation:

• Reduces the risk of cardiovascular diseases.

Limiting alcohol consumption:

• Reduces the risk of heart damage and inflammation.

Regular medical check-ups

Early detection and treatment of diseases:

• Follow your doctor's instructions and get your heart health checked regularly.
• Treat chronic conditions such as kidney failure and autoimmune diseases to reduce the risk of inflammation.

Complications

Without proper treatment, endocarditis can lead to serious complications that can affect heart function and overall health.

Cardiac tamponade

• Definition: accumulation of fluid in the pericardial cavity, which interferes with the normal functioning of the heart.
• Symptoms:

  • Low blood pressure, weakness, dizziness.
  • Rapid heartbeat, shortness of breath.
  • Swelling of veins in the neck.
• Treatment: urgent pericardiocentesis to remove fluid and relieve symptoms.

Heart failure

• Definition: the heart was unable to pump blood efficiently throughout the body.
• Symptoms: shortness of breath, tiredness, fluid retention (edema), palpitations.

Myocardial damage

• Definition: heart muscle damage that can reduce the heart's pumping ability.
• Symptoms: chest pain, shortness of breath, fatigue.
• Risk: increased risk of myocardial infarction (myocardial infarction).

Blood clot formation

• Definition: formation of blood clots in the heart valve or blood vessels.
• Risk: stroke, pulmonary embolism, peripheral arterial embolism.
• Prevention: use of anticoagulants, if necessary, according to the doctor's instructions.

Conclusion

Endocarditis is a serious inflammation of the heart valve that can cause various health problems if not treated in time and properly. Understanding the symptoms, causes, and treatment options for endocarditis is essential to preventing complications and maintaining heart health. Early diagnosis and individualized treatment can greatly improve the chances of recovery and quality of life.