Endocarditis, also called infective endocarditis, is an inflammation of the inner lining of the chambers and valves of the heart (the endocardium). It requires immediate treatment as it can lead to serious complications including heart failure.
What causes endocarditis?
Endocarditis could be due to bacterial or fungal infections and growth in the valves. The bacterial or fungal infection causes something known as ‘vegetative growth’ which clings to the heart valve and damages it. It could also cause clotting that can obstruct the blood flow in the system.
It is common to find infective endocarditis as a complication of congenital heart disease or rheumatic heart disease. However, is important to mention that infective endocarditis can present in children without any abnormal valves or cardiac malformations.
Cardiologists explain that people with valve replacement and congenital heart disease are more vulnerable to this infection. In rare cases, bacteria from gum plaques could enter the bloodstream and infect the heart linings.
“Microorganisms can travel through the blood to the heart and get lodged on the artificial valves or valves with structural abnormalities and heart tissues that are damaged,” explains Dr Gopi A, director, interventional cardiology, Fortis Hospital, Cunningham Road, Bengaluru.
Gurugram-based Dr Sanjay Chugh, director of cardiology and interventional cardiology, Aarvy Health Care Super Speciality Hospital, explains that in some people the infection could be a consequence of unhygienic intravenous drug abuse.
Signs and symptoms of endocarditis
Dr Chugh explains that the common symptoms include:
- Prolonged fever
- Shortness of breath and palpitations
Embolic skin lesions, which are tiny red or brown, raised and painful spots on the skin and nails could also point to endocarditis. Murmurs in the heart during clinical examination could likewise indicate the infection.
According to Dr Gopi A, bacteria causing endocarditis are the ones that come under the staphylococci (staph) and streptococci (strep) groups. “If the person comes with prolonged fever (two weeks) and already has a structural heart disease, you tend to suspect heart infection,” he explains.
Dr Gopi also adds that people are advised a blood test which will show infection in terms of increased WBC counts. Then an echocardiogram is done which may reflect abnormal bacterial or fungal growth on the valves. “If we see vegetation (fungal growth), it is most likely endocarditis,” explains Dr Gopi.
Risks of the infection
Experts say that the following people are at high risk of endocarditis:
- Those with an underlying congenital or valvular heart disease
- People who have had prior heart surgery, especially for congenital defects and valvular conditions
- Intravenous drug abusers
Endocarditis and its immunological consequences could affect other organs like the kidneys, brain and liver, apart from the heart.
Dr Gopi also adds that some of the fungal growth breaks off and could result in clotting leading to embolic stroke (a type of ischemic stroke that occurs when blood flow in an artery of the brain is interrupted).
“If this material reaches and blocks the renal arteries, it can cause renal failure,” he points out.
Other organs which can be affected are the eyes; there could be loss of vision in some cases. “It can also cause an issue like embolic limb (a vascular issue in the limbs) and even gut and kidney damage,” cautions Dr Chugh.
A word of caution
Dr Chugh says to protect oneself from an infection like endocarditis, a person should take antibiotics before dental or genitourinary (urogenital) procedures. Another important factor is maintaining good oral and dental hygiene to keep bacterial infections at bay. “Maintaining good immunity is crucial and important to fight all kinds of infections,” he adds.
Infective endocarditis is a bacterial infection affecting the heart chambers and valves. It could lead to serious complications including heart failure. People with an underlying congenital heart condition and heart valve disease are at higher risk. If not treated on time, it could also affect the functioning of the kidneys, brain and liver.