Inflammations of the heart: endocarditis

By Cristiano Antonino On Jun 16, 2023

Endocarditis is an inflammation of the inner membrane of the heart, the endocardium. The inflammation is caused by bacteria or, in some cases, fungi

It affects men more than women and can also affect young people between the ages of 35 and 50.

People with heart disease, artificial heart valves or congenital heart defects are more likely to contract endocarditis.

It is essential that these people contact their doctor promptly in case of ‘premonitory’ signs.

If not treated in time, it can cause irreversible damage to the valves of the heart, leading to complications such as stenosis, i.e. the pathological narrowing of blood vessels, canals, ducts, or orifices, such that the normal passage of substances circulating through it is obstructed, or valve failure.

Good oral and skin hygiene is essential to prevent endocarditis.

What is endocarditis?

The endocardium, the inner membrane of the heart, lines the inner surface of the heart and heart valves.

When the endocardium becomes inflamed, endocarditis, a serious and life-threatening disease, occurs.

Generally, endocarditis is caused by bacteria that reach the bloodstream through skin or mucous membrane lesions and ‘colonise’ the endocardium.

The heart valves, damaged and altered in their normal structure, will lose their functionality and will no longer be able to close normally; as they do not function properly, a haemodynamic overload will be created.

Thrombi may be created with consequent vascular damage, not only cardiac, and there will be insufficient blood supply to the body.

How do you notice endocarditis?

Typical signs are fever accompanied by chills and night sweats without any apparent cause, exhaustion and malaise, weight loss and lack of appetite.

In young children, on the other hand, weight gain, vomiting and weakness during feeding will occur.

Although these may be flu-like symptoms, it is important to seek medical advice in order to rule out the possibility that it may be endocarditis and to prevent it from worsening: as a delayed diagnosis of endocarditis will cause permanent damage to the heart valves and heart failure.

In general, one can distinguish

symptoms of the infectious state such as fever, headache, asthenia, malaise, lack of appetite and weight loss, nausea and vomiting, bone and muscle pain;
symptoms and signs related to the involvement of cardiac structures, including difficulty breathing, swelling of the ankles and legs, less frequently chest pain;
symptoms and signs resulting from septic embolisms or immunological phenomena such as abdominal and joint pain, headaches, back, stroke and other neurological changes, skin haemorrhages;

What are the causes of endocarditis?

A multitude of bacteria coexist on our bodies that are essential for the skin and mucous membranes.

The presence of small lesions on the skin and mucous membranes gives bacteria a way to enter the blood circulation.

Usually, these bacteria are removed from circulation by our immune system.

When the endocardium is not damaged, it will be impossible for bacteria to adhere to the heart valves.

If, on the other hand, it is damaged, bacteria will be able to settle on the surface and cause inflammation.

The lesion of endocarditis is the deposition of fibrinous material and platelets on the endocardium, within which the microorganisms that cause endocarditis nest and multiply.

The microorganisms that cause infective endocarditis are bacteria and fungi that enter the bloodstream by the oral, cutaneous, urinary or intestinal route and reach the heart.

How can endocarditis be prevented?

In order to prevent endocarditis, healthy skin and gums are essential, thus reducing the number of bacteria that enter the bloodstream.

Those who know that they are at risk should pay attention to: teeth cleaning, brushing at least twice a day and flossing at least once a day; dental hygiene by going to the dentist at least twice a year; not overdoing drinks and foods rich in sugar; promptly disinfecting wounds and consulting a dermatologist if you have skin problems, and categorically avoiding piercings and tattoos.

One could risk running into endocarditis during oral surgery as it is easier for bacteria to enter the bloodstream; those at greater risk of developing endocarditis should therefore undergo antibiotic treatment before surgery.

To follow this antibiotic treatment will be: those who have already suffered from endocarditis, those who have artificial or reconstructed heart valves.

The diagnosis of endocarditis is rather difficult, blood tests, blood culture, as well as echocardiography will have to be performed, thanks to which it will be possible to visualise the heart valves, examine their function and detect any abnormal structures on their surface.

Blood culture is the most important test for identifying the presence of specific bacteria or fungi in the blood stream, as well as identifying other possible signs of endocarditis such as systemic inflammation or anaemia.

If the diagnosis is positive, an antibiotic treatment should be followed, which will be administered by venous infusion; this treatment lasts for about 5 weeks.

At the end of the treatment, the effectiveness of the treatment will be seen by performing blood culture and echocardiography again.

If the antibiotic treatment has not worked, you will already have a severely compromised heart valve and surgery will be necessary.

You may also need to implant an artificial heart valve.