What if a germ gets into the heart? Let's learn about endocarditis in simple terms

Your heart is an amazing organ, isn't it? But sometimes, even a small germ from somewhere else in our body can travel through the bloodstream and damage the heart itself. That's one serious, even life-threatening condition we're talking about today, called endocarditis. It's very important to recognize this properly and get treatment quickly.

What is Endocarditis simply?

Simply put, endocarditis is an infection and inflammation of the inner lining of your heart (which we medically call the endocardium) and heart valves. It is usually caused by a germ, such as bacteria .

Imagine, a germ from your mouth, skin, or somewhere in your respiratory system enters your bloodstream. Then, this germ travels with the blood and goes to your heart. A healthy heart does not get infected easily. But if there is some damage or weakness in your heart valves, the germ goes and sticks to those weak spots, takes root there, and starts to multiply.

As these germs grow there, they form small growths, like blood clots and fibrous tissue. We call these `vegetations`. These `vegetations` can cause serious damage to the heart valves. This can cause the valves to not close properly, cause blood to leak, or even cause the heart to stop working completely.

There are two main types of this.

Endocarditis can be divided into two main types.

1. Infective Endocarditis: This is the most common type. As the name suggests, it is caused by a germ, such as bacteria or fungi, entering the heart. Doctors sometimes call it `(Bacterial Endocarditis - BE)`.

2. Non-infective Endocarditis: This is very rare. Here, the `vegetations` in the heart are not caused by a germ. We call these `( sterile vegetations)`. This condition usually occurs with diseases that cause the blood to clot easily. For example, it can be seen with conditions like `( lupus )` disease and `( Antiphospholipid syndrome)`.

What are the symptoms of endocarditis? How do you recognize them?

The symptoms of this disease are a bit complicated, as they can appear suddenly, or they can appear gradually over weeks.

Infective endocarditis can come in two forms:

• Acute: This starts suddenly. It can become life-threatening within a few days, with symptoms such as high fever and rapid heartbeat .
• Subacute: This develops slowly, over weeks or months.Symptoms such as a feeling of weakness and a slight fever are the first to appear.

Non-infective endocarditis usually does not cause symptoms. It is the symptoms of the underlying disease (such as lupus) that cause it that appear.

Who is at higher risk of developing this?

Endocarditis is not a very common disease, but some people are at higher risk of developing it.

• People with artificial heart valves , pacemakers, or defibrillators : These devices are more likely to become contaminated with germs.
• People who have had endocarditis before: If you have had it once, there is a risk of it happening again.
• People with certain heart conditions: especially heart valve disease and hypertrophic cardiomyopathy.
• IV drug users: Germs can enter the bloodstream directly through dirty injection needles.
• People with poor oral and dental hygiene: Bacteria in the mouth can easily enter the bloodstream due to tooth decay and gum disease.
• People with a weak immune system: People with diseases such as diabetes or those taking medications that suppress the immune system.
• People who have had previous heart valve surgery.

What are the complications if left untreated?

What can happen if treatment is delayed:

• Heart valves are completely destroyed, causing blood to leak (Leaky heart valve)
• Heart failure
• Abscesses around the heart
• Irregular heartbeat (Arrhythmia)
• Small pieces of those vegetations can break off and block a blood vessel in the brain, causing a stroke.
• The infection spreads throughout the body, causing a fatal condition called sepsis.
• Ultimately, death may even occur.

How do doctors find this?

If you have symptoms and risk factors, your doctor will make a diagnosis as soon as possible. This will mainly involve several tests.

• Blood tests:
• Blood culture test:This is how you find out exactly what type of bacteria is in the blood.
• Complete blood count: Check for infection.
• C-reactive protein test: Checks for swelling in the body.

• Imaging tests of the heart:
• Echocardiogram: This is a scan of the heart. It can clearly see how the heart is functioning, any damage to the valves, and whether there are any `vegetations`.
• Transesophageal echocardiogram: This is also a type of echo. However, a small tube is inserted through the throat and scanned closer to the heart. This can produce even clearer images.
• Heart MRI scan: In some cases, this test may also be necessary.

What are the treatments?

Endocarditis is a condition that requires hospitalization and treatment. The main treatment is intravenous antibiotics (IV antibiotics).

This treatment will be continued for several weeks, sometimes as long as 6 or 8 weeks. Once the type of bacteria in your blood is identified, your doctor will choose the right antibiotic for it. During your treatment, your symptoms will be monitored regularly, and your blood tests will be repeated to make sure the infection is gone.

Can this situation be prevented?

Although it is not possible to completely prevent it, there are things we can do to reduce the risk. You should be especially careful about these things if you are in a high-risk category.

• Maintain good oral and dental hygiene: Brush your teeth thoroughly every day. Clean between your teeth. Visit your dentist regularly to check your oral health. This is the most important thing.
• Special advice for high-risk individuals: If you have a prosthetic valve, have had endocarditis in the past, or have other high-risk heart conditions, your doctor may recommend that you take prophylactic antibiotics before certain dental procedures (e.g., tooth extractions, gum surgery). This is to kill bacteria that may enter the bloodstream during dental procedures before they reach the heart.
• Inform your doctors:Always keep your family doctor and dentist informed about your heart condition and risk of endocarditis.