Infective Endocarditis
Heart
Valves and Infective Endocarditis
What
is infective endocarditis?
Infective
endocarditis, also called bacterial endocarditis, is an infection caused by
bacteria that enter the bloodstream and settle in the heart lining, a heart
valve or a blood vessel. IE is uncommon, but people with some heart conditions
have a greater risk of developing it.
Infective
endocarditis refers to infection in the lining of the heart, but also affects
the valves. It often affects the muscles of the heart.
Endocarditis is an
inflammation or infection of the inner surface of the heart (the endocardium).
It occurs when bacteria enter the bloodstream and attach to a damaged portion
of the endocardium or abnormal heart valves. But it may also develop on devices
implanted in the heart, such as artificial heart valves, pacemakers, or
implantable defibrillators.
There are two forms of infective endocarditis, also known as
IE:
- Acute
IE —
develops suddenly and may become life threatening within days
- Subacute
or chronic IE (or subacute bacterial endocarditis) — develops slowly
over a period of weeks to several months.
How
do people contract infective endocarditis?
The infection can be caused by
bacteria introduced into the blood stream. Infection can result from many
sources, including poor dental hygiene, tooth brushing that causes minor injury
to the lining of the mouth or gums, dental procedures, implanted cardiovascular
medical devices, chronic skin disorders and infections, burns, infectious
diseases and more. These bacteria can lodge on heart valves and cause infection
of the endocardium.
Why
does endocarditis pose a threat to the heart valves?
The heart valves are not supplied
directly with blood. Therefore, the body’s immune response system, including
the infection-fighting white blood cells, can't directly reach the valves
through the bloodstream. If bacteria begins to grow on the valves (this occurs
most often in people with already diseased heart valves), it is difficult to
fight the infection, whether through the body’s own immune system or through medications
that rely on the blood system for delivery.
Who's
at risk for infective endocarditis?
Risk factors for children and young
adults include birth defects of the
heart such as malformed valves or a hole in the septum, which
allow blood to leak from one part of the heart to another.
Risk
factors for adults include previous valve surgeries or a heart transplant,
calcium deposits in the mitral valve or in the aortic valve, congenital heart
defects or a history of endocarditis.
Illicit
drug use and IE
If the cause of IE is
injection of illicit drugs or prolonged use of IV drugs, the tricuspid valve is
most often affected. Street drugs, including narcotics, can also affect the
mitral or aortic valve.
What
are the symptoms of infective endocarditis?
The symptoms of acute IE usually begin
with fever (102°–104°), chills, fast heart rate, fatigue, night sweats, aching
joints and muscles, persistent cough, or swelling in the feet, legs or abdomen.
The
symptoms of chronic IE may include fatigue, mild fever (99°–101°), a moderately
fast heart rate, weight loss, sweating, and a low red blood cell count
(anemia).
Treatment
usually consists of IV antibiotics. The choice of antibiotic and the length of
treatment is based on the type of infection causing the endocarditis.
Prevention
for those at risk usually involves awareness of the risks, and preventative
antibiotics prior to certain surgical, dental and medical procedures.
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