Endocarditis is inflammation of the membrane (endocardium) that lines the valves and chambers of the heart, usually due to a bacterial, fungal or viral infection. It can damage or destroy heart valves if left untreated. A cause of infection can reach through the mouth, so dental and oral hygiene becomes important in the face of this pathology. People at highest risk for endocarditis tend to be patients with heart valve damage, patients with artificial heart valves, or people with congenital heart defects.
Causes of endocarditis
Bacterial, fungal or viral infection
Endocarditis is usually identified as ‘infectious endocarditis’ although most cases are caused by bacterial infections; mainly, for:
– ‘Staphylococcus aureus’
– ‘Streptococcus viridans’
– ‘Streptococcus bovis’
– ‘Streptococcus pneumoniae’
– ‘Enterococcus’
– ‘Pseudomonas aeruginosa’
– ‘Candida’
– ‘Haemophilus parainfluenzae’
– ‘Actinobacillus hominis’
– ‘Cardiobacterium’
– ‘Eikenella corrodens’
– ‘Kingella kingae’
Disease classification can be identified based on the location of the infection; by means of acquisition (bleeding gums that encourage the entry of bacteria into the bloodstream; catheterizations, contaminated needles and syringes, tattoos and/or piercings…) and according to the microbiological results.
Suffering from systemic lupus erythematosus and some type of thrombophilia can favor the attachment of the infection to lesions in the endocardium. In the case of virulent infections they can adhere directly to the intact endothelium.
Symptoms of endocarditis
Fever, heart murmur that appears for the first time or that is different from the existing one, chills, pain and others
The development of endocarditis can cause various symptoms and its onset can be sudden or slow depending on the cause. Some symptoms are:
– Fever and chills.
– Heart murmur that appears for the first time or that is different from the existing one.
– Fatigue.
– Pain in joints and muscles.
– Night sweats.
– Difficulty and/or pain in the chest when breathing.
– Swelling in the feet, legs or abdomen.
– Involuntary weight loss.
– Blood in the urine.
– Light pain in the spleen.
– Red spots on the sole of the foot or the palm of the hand (Janeway lesions).
– Sensitive red spots under the skin of the fingers or toes (petechiae or Osler’s nodules).
If endocarditis is not treated, it can cause complications such as bacterial clumps and cell fragments (vegetations) that can break off and travel to the lungs, brain, abdominal organs, kidneys or extremities.
Diagnosis of endocarditis
It is key to identify the cause
The doctor needs to identify the cause of endocarditis in order to prescribe the appropriate treatment. For them, in addition to the medical history and treatment of symptoms, blood tests with blood cultures will be performed to detect fungi or bacteria; echocardiogram; transthoracic echocardiogram; electrocardiogram; chest x-ray; computed tomography; and MRI of the brain, chest and other parts of the body to check the extent of the infection.
Endocarditis treatment and medication
Antibiotics and in extreme cases, surgery
Typically, antibiotic treatment is sufficient to treat endocarditis, although the treatment will probably be performed intravenously in the hospital and later in the health center when symptoms have stabilized and the patient is discharged from the hospital. Self-monitoring is key as any change in symptoms such as an increase in fever or chills, the appearance of headaches, joint pain and, especially, difficulty breathing or the appearance of skin rashes or joint pain must be reported. .
If the valves are affected, the specialist may suggest heart valve repair or replacement surgery.
Prevention of endocarditis
Take care of your mental health and avoid any open wounds
If there is a risk of the appearance of endocarditis or to prevent it in any case, the recommended guidelines are:
– Know the symptoms and be suspicious of unexplained fatigue, especially if there are wounds or sores that do not heal correctly.
– Brush your teeth, gums and tongue frequently, making sure there are no wounds or bleeding and performing regular oral check-ups with a stomatologist or dentist.
– Avoid procedures that can cause skin infections, such as tattoos and body piercings.
– If there is a risk of suffering from endocarditis, it is very important to communicate this to any medical specialist in case you have to follow any procedure so that they can evaluate whether a preventive antibiotic should be prescribed.
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