Is your heart infected? Let's talk about (Endocarditis)!

Have you ever heard that the heart can get infected? Sometimes this can be quite serious. Today we are going to talk about a condition that affects the inner lining of the heart. We call this `(Endocarditis)`. Because this can be quite serious, it is very important to be aware of this.

So what is this `(Endocarditis)`?

Simply put, Endocarditis is an inflammation or swelling of the inner lining of your heart, the thin membrane that lines the chambers and especially the heart valves – we call it the endocardium. Just like the walls of a house, the heart also has a thin lining inside. That's what the endocardium is.

With this inflammation, small growths, like sprouts, start to form on the inner lining of the heart. We call these `vegetations`. As these `vegetations` continue, the surrounding heart tissue gradually begins to be destroyed. It's like an insect eating a leaf from a tree. This can cause serious damage to your heart valves. If left untreated, `(Endocarditis)` can be fatal. So it's very important to be aware of this.

What are the main types of `(Endocarditis)`?

Now look, there are two main types of `(Endocarditis)`.

1. Infective Endocarditis

2. Non-infective Endocarditis

1. What is Infective Endocarditis?

This is the most common type of endocarditis. What happens here is that germs – most often bacteria – stick to the damaged tissue of your heart and cause an infection. Doctors sometimes call this bacterial endocarditis or BE.

In this `(Infective Endocarditis)`, the `(vegetations)` mentioned earlier are formed by the following things:

• Infecting organisms (such as bacteria or sometimes fungi)
• `(Fibrin)` (This is a protein that helps blood clot)
• Platelets (small cell fragments in the blood)

Think about it, just like putting a bandage on a wound, these germs, `(Fibrin)` and `(Platelets)` come together to form those `(vegetations)` inside the heart.

2. What is Non-infective Endocarditis?

This type is very rare. Here too, those `(vegetations)` form on the inner layer of the heart, but the cause is not an infection. That is why these are called `(sterile vegetations)`, which means `(vegetations)` without germs.

Non-infective endocarditis is a condition that is associated with conditions that make your blood clot easily (a `hypercoagulable state`). For example:

• `(Antiphospholipid syndrome)`
• `(Lupus)` (Some people also call this `(Systemic Lupus Erythematosus)`)

Doctors use several other names for this condition (Non-infective Endocarditis):

• `(Libman-Sacks endocarditis)`
• `(Non-bacterial thrombotic endocarditis)` or `(NBTE)`
• `(Marantic endocarditis)`

What are the symptoms of `(Endocarditis)`? How to recognize it?

Now let's see what symptoms can occur in this `(Endocarditis)` condition. You should be very careful about these symptoms.

Symptoms of Infective Endocarditis:

These are the most commonly seen symptoms:

• Chest pain
• An abnormal heart sound (a ``heart murmur'' that a doctor hears when listening with a ``stethoscope'')
• Increased heart rate (Tachycardia)
• Fatigue
• Fever (may be greater than 38.4°C or 100°F)
• Chills and night sweats
• Loss of appetite and weight loss
• Muscle and joint aches
• Difficulty breathing (`(Dyspnea)`)
• A skin rash, that is, a rash like a rash.
• Swelling in your abdomen or legs
• Blood in the urine (`(Hematuria)`)

The most important thing is that if you have these symptoms, you should go to a hospital emergency room immediately. Infective Endocarditis is a life-threatening condition.

The condition `(Infective Endocarditis)` can affect in two ways:

• Acute: This starts suddenly. It can become life-threatening within a few days, with symptoms such as high fever and rapid heartbeat.
• Subacute: This is a gradual process. Symptoms may appear gradually over a period of weeks or months.

Symptoms of Non-infective Endocarditis:

There are usually no specific symptoms associated with this type of endocarditis. However, you may have symptoms of an underlying medical condition (such as lupus) that is causing it. Most people with non-infective endocarditis are unaware that they have it, and it is discovered incidentally when an imaging test (such as an echocardiogram) is done for another reason. Sometimes, the condition is found at autopsy.

What are the causes of Endocarditis?

Most often, the main cause of endocarditis is a bacterial infection . These bacteria enter your bloodstream from somewhere else in your body – for example, your mouth, skin, or respiratory system – and travel through the bloodstream to your heart.

Just think, if we have a wound in our mouth, if there are germs behind our teeth, if we pull out a tooth, sometimes those germs can get into the blood.

Healthy heart tissue is usually resistant to infection. That is, it does not get infected easily. However, if there is any damage or weakness in the heart, the chances of developing `(Endocarditis)` are high. Those bacteria come and stick to the damaged tissue and start growing there. As mentioned earlier, they make what is called `(vegetations)`, and they also produce various enzymes. Due to this process, the tissues around the heart start to be destroyed. To be precise, the heart valves are the ones that are damaged the most.

What factors increase the risk of developing `(Endocarditis)`?

Generally speaking, `(Endocarditis)` is not a very common disease. However, there are some factors that increase your risk of developing this disease. Let's see what they are:

• If you have an artificial heart valve, pacemaker, or defibrillator implanted in your heart, it is easy for bacteria to attach to these devices.
• If you have diabetes. Diabetes can reduce the body's ability to fight infections.
• Some heart conditions, especially heart valve disease and hypertrophic cardiomyopathy (abnormal thickening of the heart muscle).
• Intravenous drug use (IV substance use). This can introduce germs directly into the bloodstream by using unclean needles.
• Poor dental health and gum disease. Bacteria in the mouth can enter the bloodstream and travel to the heart.
• If you have previously developed `(Bacterial Endocarditis)`.
• If you have had previous heart valve surgery.
• If the immune system is weakened, diseases such as HIV/AIDS, cancer treatments, or certain medications can weaken the immune system.

What are the possible complications of `(Endocarditis)`?

Endocarditis is not something to be taken lightly. If not diagnosed and treated early, it can lead to serious complications. Here's what can happen:

• Abnormalities in the heart rhythm (Arrhythmia)
• Abscesses around heart valves
• Heart block (interference in the conduction of electrical signals in the heart)
• Heart failure (heart failure)
• Leaky heart valve
• Sepsis (a severe infection that spreads throughout the body)
• Stroke (if fragments of the vegetations break off and block a blood vessel in the brain)
• Even death can occur.

That's why we say to seek medical advice immediately if you have symptoms, because if these complications occur, the situation can be very serious.

How do doctors diagnose Endocarditis?

If you have symptoms of `(Endocarditis)` and you have risk factors, your doctor will try to diagnose the disease as soon as possible, because it is very important to start treatment quickly.

Tests like these are done to diagnose Endocarditis:

Blood tests:

• Bacterial culture tests: These can determine exactly what type of bacteria is in your blood. This is very important for choosing treatment.
• Complete blood count (CBC): This can be used to check the number of cells in the blood and give an idea of ​​an infection.
• C-reactive protein test (CRP): This shows whether there is inflammation in the body.

Imaging tests:

These tests can check for heart `vegetations` and damage to the heart. Your doctor may recommend one or more of these tests:

• Echocardiogram: This is like an ultrasound scan of the heart. It can check the function of the heart, the condition of the valves, and whether there are any vegetations.
• Transesophageal echocardiogram (TEE): This involves passing a small camera-equipped tube down the throat to get a clearer view of the heart through the esophagus. It can produce clearer images than a regular echocardiogram.
• Heart MRI: This can also provide detailed images of the heart.

What are the treatments for `(Endocarditis)`?

Endocarditis is a life-limiting disease. Prompt treatment is needed to stop damage to your heart valves and prevent more serious complications.

Antibiotics:

You will most likely need to take intravenous antibiotics (IV antibiotics) for several weeks – usually about six weeks . This is what will completely cure the infection. Once the exact type of bacteria in your blood is known, your doctor can change the antibiotics to suit.

Throughout your treatment, your doctor will regularly monitor your symptoms to see if the treatment is working. They will also repeat the bacterial culture tests.

Surgery:

If endocarditis has damaged one of your heart valves or another part of your heart, you may also need surgery. For example, you may need to repair a damaged valve or have a new valve inserted.

Can this disease be prevented?

Endocarditis cannot always be prevented. However, if you are at high risk for developing this disease (remember the risk factors mentioned earlier?), or if you have had endocarditis before, your doctor may recommend that you take prophylactic antibiotics before certain dental procedures. Examples of such dental procedures include:

• Treatment for your gums
• Treatments related to the periapical area of ​​your teeth
• Treatments related to the oral mucosa

It is very important to inform your doctors (general practitioners and dentists) that you have a heart condition that puts you at high risk of developing `(Endocarditis)`. Also, keep something like an ID card in your purse that includes the necessary antibiotic guidelines. The `(American Heart Association)` provides such cards (in Sri Lanka, you can ask your doctor about this).

If I have `(Endocarditis)`, what should I expect?

You can expect to take antibiotics for two to eight weeks to clear up the infection. Most people recover from endocarditis with good, prompt treatment. However, the risk of serious complications or death depends on things like:

• your age
• Whether or not you have an artificial heart valve
• How long the infection has been present
• What kind of organism (type of bacteria) made you sick?
• How much damage has been done to your heart valve?

Your doctor can give you a better idea of ​​what to expect based on your condition.

With good treatment, most people recover from `(Endocarditis)`. Be aware of the symptoms of `(Endocarditis)` and go to the emergency room immediately if you think you have it. Also, keeping your teeth and mouth clean can reduce your risk of developing `(Endocarditis)`. This includes brushing your teeth daily and seeing your dentist regularly for check-ups.

So, what are the most important things we need to remember from this story?

Okay, so we've talked a lot about `(Endocarditis)`. In summary, it's worth keeping these points in mind:

• Endocarditis is an inflammation of the inner lining of the heart, especially the valves. The main cause of this is a bacterial infection.
• If you have symptoms like fever, chills, fatigue, shortness of breath, or chest pain , don't take them lightly. Be especially careful about these symptoms if you have heart disease, a prosthetic heart valve, or a risk factor like diabetes.
• If symptoms appear, do not waste time and seek medical advice immediately. Prompt treatment can save lives and prevent serious complications.
• Taking care of your oral health is very important. Brush your teeth well every day and see a dentist regularly. This will help prevent `(Endocarditis)`.
• If you are at high risk for endocarditis, talk to your doctor about whether you should take prophylactic antibiotics before dental treatment.

Remember, this information is to educate you, not to scare you. Awareness is very important for a healthy life. If you have any concerns, never be afraid to talk to a doctor.

` Endocarditis, heart infections, heart valves, bacteria, fever, shortness of breath, dental health