Infective Endocarditis - Types, Causes, Risk Factors, Diagnosis and Treatment

Overview:

Infective endocarditis is an infection that is caused by microbes. It is known to affect the heart. The most common site of occurrence for infective endocarditis is the existing damage in the heart valves. It can also occur in any prosthesis.

How Does Infective Endocarditis Occur?

Many layers line the heart. The endothelium is a layer that is found in the internal areas of the heart. If there is high pressure in the heart's pumping mechanism, it can result in valvular damage. The area that has been damaged will have a platelet adhesion and aggregation. It will also be accompanied by fibrin deposition. This will represent the non-bacterial thrombotic endocarditis.

If any organisms enter the body and reach the blood, it might become an infectious site in the body. This can grow further and lead to the obstruction of organs. In severe cases, abscess formation is seen. The most commonly affecting group of bacteria are known as the HACEK group. They are Haemophilus, Actinovacillus, Cardiobacterium, Eikenella, and Kingella.

What Are the Types of Infective Endocarditis?

Infective endocarditis is classified into two types depending on the duration of occurrence. They are acute and sub-acute.

• Acute Infective Endocarditis: Acute infective endocarditis occurs in a very short duration. It can result in severe complications like the destruction of the valve and the formation of an abscess. It can lead to the spread of infection to different sites. The process of spreading the infection to other organs or tissues is known as metastasis. This type of metastatic spread is commonly seen in acute infective endocarditis. The most common organisms causing acute infections are Staphylococcus aureus and Pneumococci. In some patients affected by acute infective endocarditis, organisms like Beta-hemolytic streptococci are known to be the causative agent.

• Subacute Infective Endocarditis: Subacute infective endocarditis is known to occur relatively slower than the acute infective endocarditis. This type of ineffective infective endocarditis is painful to a certain extent. There will be structural damage to the tissues that occur in a slow manner. The metastatic spread is rare in subacute infective endocarditis. But, other complications like splenomegaly and clubbing are seen. In clubbing, there will be enlargement of the fingers and toes. In splenomegaly, there will be enlargement of the spleen. All the spleen's important functions will be disrupted due to the abnormal immune responses or infiltration of destructive cells. In advanced stages, petechial hemorrhages are seen. This condition causes discoloration and bleeding of the tissues.

What Are the Recommended Dental Procedures?

The patient will be recommended to perform a few dental procedures before starting the treatment for infective endocarditis. This is done as a prophylactic measure. In case of failure to perform these dental procedures, it will increase the risk for infective endocarditis. The recommended procedures are:

• Scaling, and root planing.

• Extraction.

• Antibiotic strips that are placed subgingivally.

• Intra-ligament injections.

• Root canal procedures.

• Implant placement.

• Orthodontic bands.

Few procedures need not require separate prophylaxis for infective endocarditis. They are:

• Oral radiography.

• Rubber dam placement.

• Treatment with fluoride.

• Removal of sutures.

• Impression for prosthodontic procedures.

What Are the Symptoms of Infective Endocarditis?

The symptoms are known to differ from person to person. The time taken for the development of symptoms might also vary. The common symptoms of infective endocarditis are:

• Chest pain.

• Fever.

• Blood in the urine.

• Weakness.

• Red skin rash.

• Weight loss.

• Chills.

• White spots on the tongue or in the mouth.

• Fatigue.

• Sweating.

• Cough.

• Pain and swelling in joints.

• Abnormal urine color.

• Muscle aches and tenderness.

• Sore throat.

• Shortness of breath.

• Nausea or vomiting.

• Sinus congestion and headache.

• Duke's Criteria. There will be an occurrence of three clinical features that are together referred to as Duke's criteria. They are:

• Osler Nodes: They are very painful lesions. It can occur at the fingertips.

• Janeway's Lesions: They are macular lesions which occurs in the soles and palms.

• In the ocular examination, Roth spots will be seen.

If infective endocarditis is not treated in the initial stage, it can lead to life-threatening complications. Since it resembles other conditions, a proper diagnosis is required.

Who Is at High Risk of Infective Endocarditis?

People with the following conditions are known to be at high risk.

• Congenital heart disease.

• Artificial heart valves.

• Damaged heart valves.

• Heart valve disease.

• Hypertrophic cardiomyopathy.

• Valve regurgitation.

• Mitral valve prolapse.

• Drug usage.

How Is Infective Endocarditis Diagnosed?

Duke's criteria are one of the methods to identify the infective endocarditis. It would require the help of findings from echocardiography. Laboratory diagnosis and clinical findings are also essential. The standard diagnostic methods that are used for the diagnosis of infective endocarditis are:

• Blood Examination: A routine blood examination is carried out to identify the type of organism present in the blood. With this, the doctor can prescribe specific antibiotics. The blood samples are taken at thirty minutes intervals from different sites of the body. If the test results are not helpful, then a serological test might be required.

• Echocardiography: Echocardiography is a method to identify the exact site and size of the infection. Any type of abscess formation can be easily detected in echocardiography. Severe cardiac problems like heart failure can be diagnosed with this tool. There are different types of echocardiography, such as transesophageal echocardiography and transthoracic echocardiography. The transesophageal echocardiography method is known to be more precise compared to transthoracic echocardiography.

• Chest X-ray: Chest X-ray is a conventional diagnostic tool that is very helpful in the identification of any abnormalities of internal organs. The conditions like heart failure and cardiomegaly can be detected with chest X-rays.

What Are the Treatment Options for Infective Endocarditis?

The treatment of infective endocarditis can be done both with medications and surgical options. The first line of treatment would be aimed at healing the patient by providing medication. In case of severe condition only, surgical option is preferred.

• Medications: After identifying the causative organism, the antibiotics are prescribed accordingly. The most commonly used antibiotics are Ampicillin, Penicillin, Vancomycin, Cefazolin, and Gentamicin. Gentamicin is the preferred drug for subacute infective endocarditis. It is prescribed along with Ceftriaxone. In case of prosthetic valve endocarditis, medications like Vancomycin are prescribed. Penicillin is prescribed for approximately two to four weeks. Gentamicin is prescribed for two weeks, and Vancomycin is prescribed for approximately four to six weeks.

• Surgery: It is essential to perform surgery if the valves of the heart are damaged. Your doctor will formulate a proper treatment plan on the advice of a surgeon. The replacement of valves can be done by placing a new valve obtained from artificial or animal tissues. Surgery should be the option only if the antibiotics are not working.

What Are the Precautionary Measures?

There are a few ways to prevent infective endocarditis, they are:

• Look for any abnormal signs. If you are affected by a fever that is causing you extreme tiredness, you should immediately consult your doctor.

• If you have a cut or open wound that is not healing for a longer duration, then you should pay attention to this.

• Dental health plays a vital role in infective endocarditis. Poor oral hygiene is a predisposing factor. It is essential to maintain proper oral hygiene. Brushing, flossing, and regular dental checkups will contribute to good oral health.

• If there are any skin infections due to tattoos and piercing in the body, it is a factor that you have to give importance to.

You can get help from our online doctors.