Endocarditis

1. Endocarditis Lyndsey Sarpy

2. What is Endocarditis? Endocarditis is an infection of the endocardium (inner lining of the heart)

3. Symptoms of Endocarditis Endocarditis may develop slowly or suddenly, depending on what is causing the infection • Fever, chills, and sweating are the classic symptoms. They sometimes can be present for days before any other symptoms appear. They can come and go, or can be more noticeable at nighttime. • A new or changed heart murmur (abnormal heart sounds made by blood rushing through the heart) • Fatigue • Aching joints and muscles • Shortness of breath

4. Symptoms of Endocarditis • Paleness • Persistent cough • Swelling in feet, legs, or abdomen • Unexplained weight loss • Blood in the urine (either visible or found when viewing under a microscope) • Tenderness in the spleen (left side, just below the rib cage) • Osler’s nodes (red, tender spots under the skin of the fingers • Petechiae (tiny purple or red spots on the skin, whites of the eyes, or inside of the mouth)

6. Causes of Endocarditis Endocarditis can involve the heart muscle, heart valves, or lining of the heart. Most people who develop endocarditis have a: • Birth defect of the heart • Damaged or abnormal heart valve • History of endocarditis • New heart valve after surgery

7. Causes of Endocarditis Endocarditis occurs when germs enter the bloodstream and travel to the heart. Bacteria cause most cases, but fungi or other microorganisms may also be responsible. Sometimes the culprit is one of many common bacteria that live in the mouth, throat, or other parts of the body. • Everyday oral activities. Activities such as brushing your teeth or chewing food can allow bacteria to enter the bloodstream, especially if your teeth and gums are in poor condition. • An infection or other medical condition. Bacteria may spread from an infected area, such as a skin sore. Gum disease, a sexually transmitted disease, or an intestinal disorder, such as inflammatory bowel disease, also may give bacteria the opportunity to enter the bloodstream.

8. Causes of Endocarditis • Catheters or needles. Bacteria can enter the body through a catheter (thin tube that doctors sometimes use to inject or remove fluid from the body). The bacteria that can cause endocarditis can also enter the bloodstream through the needles used for tattooing or body piercing. Contaminated needles and syringes are a concern for people who use intravenous (IV) drugs. • Certain dental procedures. Some dental procedures that can cut your gums may allow bacteria to enter the bloodstream. Typically the immune system destroys bacteria that make it to the bloodstream. Even if bacteria reach the heart, they may pass through without causing an infection.

9. Tests and Diagnosis The infection can mimic other illnesses in its early stages. Various tests may be necessary to help make the diagnosis: • Blood tests. The most important test is a blood culture used to identify bacteria in the bloodstream. Blood tests can also help identify certain conditions, including anemia. • Transesophageal echocardiogram. An echocardiogram uses sound waves to produce images of the heart at work. This type of echocardiogram allows the doctor to get a closer look at the heart valves. It is often used to check for vegetations or infected tissue. During this test, an ultrasound devise is passed through the mouth and into the esophogus.

11. Tests and Diagnosis • Electrocardiogram (ECG). The doctor may order this noninvasive test if he or she things endocarditis may be causing an irregular heartbeat. During an ECG, electrodes that can detect electrical activity of the heart are attached to the chest and sometimes to the limbs. An ECG measures the timing and duration of each electrical phase in the heartbeat. • Chest X-ray. X-ray images help the doctor see the condition of the lungs and heart. The doctor can use X-ray images to see if endocarditis has caused the heart to enlarge or if the infection has spread to the lungs. • Computerized tomography (CT) scan or magnetic resonance imaging (MRI). A CT or MRI scan of the brain, chest, or other parts of the body if the doctor thinks the infection has spread to these areas.

12. Treatment • Hospitalization may be necessary at first to receive antibiotics through a vein (IV). Blood cultures and tests will help the doctor choose the best antibiotic. • Antibiotic therapy for 4-6 weeks to fully remove all the bacteria from the heart chambers and valves. • Surgery to replace the heart valve is usually needed when: • The infection is breaking off in little pieces, resulting in strokes • The person develops heart failure as a result of damaged heart valves • There is evidence of more severe organ damage

13. Prognosis Getting treatment for endocarditis right away improves the chances of a good outcome. More serious problems that may develop include: • Brain abscess • Further damage to the heart valves, causing heart failure • Spread of the infection to other parts of the body • Stroke, caused by small clots or pieces of the infection breaking off and traveling to the brain

14. Prevention Because people with the following heart conditions are at risk of more serious outcomes from endocarditis, they may need to take preventative antibiotics before certain medical or dental procedures to prevent endocarditis: • Artificial (prosthetic) heart valve • Previous endocarditis infection • Certain types of congenital heart defects • Heart transplant complicated by heart valve problems

15. Prevention Practice good hygiene: • Pay special attention to dental health – brush and floss teeth and gums often, and have regular dental check-ups • Avoid procedures that may lead to skin infections, such as body piercings or tattoos • Seek prompt medical attention if any type of skin infection develops or open cuts or sores do not heal properly