Libman-Sacks Endocarditis - Causes, Symptoms, Diagnosis, and Treatment

Introduction:

Libman-Sacks endocarditis was initially described in 1924 by Emanuel Libman and Benjamin Sacks in the United States of America. Libman-Sacks endocarditis is also known as verrucous endocarditis or marantic endocarditis. Libman-Sacks endocarditis is a kind of NBTE- nonbacterial thrombotic endocarditis. Libman-Sacks endocarditis develops a sterile vegetative growth on the surface of the cardiac valves, which are small particulate or microscopic in size to large and visible growths. The sterile vegetative growth on the heart valves during Libman-Sacks endocarditis is linked with SLE- systemic lupus erythematosus, malignancy, and antiphospholipid antibody and does not prevail any kind of infection in the patient. The mitral and the aortic valves are the two most commonly involved heart valves in Libman-Sacks endocarditis.

The heart has four chambers- two upper sections called the right atrium and left atrium, and two lower sections called the right ventricle and left ventricles. Parallel to four chambers, the heart has four valves- mitral valve, tricuspid valve, aortic valve, and pulmonary valve. Valves are a crucial part of the heart’s structure. They open and close as the blood passes through them. They mainly regulate the entry and exit of blood into the heart’s various chambers. The valves have flaps or leaflets that open and close. Valves with three leaflets open and close simultaneously. In order to avoid any sort of backflow of blood, the leaflets close, and vice verse is why they open.

What Are the Causes of Libman-Sacks Endocarditis?

Libman-Sacks endocarditis is the vegetative sterile growth on the cardiac valves that do not develop any infections in the patient. There are no determined and established causes of Libman-Sacks endocarditis, but there are several studies done to understand the etiological factors behind the same. Mentioned below are a few of the reported causes of Libman-Sacks endocarditis.

• Endothelial injury.

• Hypercoagulable state of the tissues.

• Presence of malignancies.

• Diagnosis of solid tumor.

• Adenocarcinoma.

• Systemic lupus erythematosus or SLE.

• Antiphospholipid antibody syndrome or APS.

• Endocarditis.

• Cancers of the lungs, ovary, pancreas, biliary, colon, and prostate.

• Antiphospholipid syndrome.

• Rheumatoid arthritis.

• Sepsis.

• Intravascular coagulation.

• Circulating cytokines.

• Presence of tumor necrosis factor- TNF.

• Interleukins.

• Deposition of platelet thrombi.

• Presence of inflammatory molecules.

• Accumulation of mononuclear cells and fibrin.

• Active verrucae along with plasma cells and necrotic lymphocytes.

• Healed lesions of the body.

• Necrotic and active lesions.

What Are the Signs and Symptoms of Libman-Sacks Endocarditis?

The clinical manifestations of Libman-Sacks endocarditis are parallel to the underlying cardiovascular disease. Thus determination and treatment of the present cardiovascular condition are vital. Mentioned below are a few of the signs and symptoms of Libman-Sacks endocarditis.

• Shortness of breath.

• Chest pain.

• Fatigue.

• Dizziness.

• Fainting.

• Fever.

• Rapid weight gain.

• Irregular heartbeat.

• Fluttering sensation in the chest.

• Lightheadedness.

• Coughing.

• Swollen ankles.

• Bloating of the abdomen.

• Tightness in the chest.

• Difficulty sitting up.

• Insomnia.

• Inability to engage in physical activities.

• Tiredness after a short distance walk.

• Heavy breathing after and while climbing stairs.

• Heart murmurs.

• Enlargement of the liver.

• Palpitations.

• Swelling of the feet.

• High or low blood pressure depends on the affected valve.

• The abnormal rhythm of the heart.

• Palpitations.

• Distended neck veins.

• Abdominal swelling.

• Discomfort while sitting up.

How to Diagnose Libman-Sacks Endocarditis?

Libman-Sacks endocarditis may not be diagnosed during a regular consultation with a physician post a few extra diagnostic tests. A stethoscope can pick up any abnormal heart murmurs and regurgitation sounds. To confirm the presence of valvular regurgitation or valvular stenosis, additional tests such as those mentioned below may be suggested. Physical examination and a detailed account of medical as well as drug history are vital for the diagnosis of Libman-Sacks endocarditis.

• Complete blood picture.

• Doppler echocardiography.

• An echocardiogram for the ultrasound of the heart is a non-invasive test that studies the wave of the heart's motion chambers and valves. This is one of the most useful diagnostic tools for cardiac angiosarcoma because it allows the healthcare provider to locate the tumor and determine its exact size.

• A transesophageal echocardiogram is another diagnostic tool guided down the throat and the esophagus directly into the heart, giving a much more detailed picture.

• Electrocardiogram, also called an EKG for ECG, records the heart's electrical activity and shows any abnormal heart sounds or heart murmurs. In addition to this, it also observes any damage present in the cardiac muscles.

• A computed tomography scan combines X-ray and technology to produce slices or horizontal and axial images of the body, showing a detailed picture of the desired organ. Along with the size and location, other in-depth features can be understood with the help of a CT or computed tomography scan.

• Magnetic resonance imaging MRI is a diagnostic tool that uses computers and radio frequencies to produce a detailed image of The structures of the body.

• An X-ray of the chest uses electromagnetic energy to detect any enlargement of the heart or condition of the lungs.

• Cardiac catheterization is a procedure where X-rays are taken after a contrast dye is injected into the heart's arteries. This procedure helps detect any abnormalities in the cardiac arteries and blood vessels.

• A biopsy of the heart refers to a tiny amount of tissue examining it under a microscope that may suggest the presence of cancer if the pathologist analyses and studies the tissue.

What Is the Treatment of Libman-Sacks Endocarditis?

There have not been a lot of definitive treatment modalities as of today for Libman-Sacks endocarditis. The optimal management approaches are yet to be determined, and the ones that are present today are not defined well. This is because several recommendations for the treatment of Libman-Sacks endocarditis are made with clinical trials and randomized case studies, both of which have not been done to a great extent. The nature of the disease additionally plays a role in the lack of progressive treatment and management modalities; the presence of any underlying disease, such as systemic lupus erythematosus, requires clearance and complete recovery before going into the management of Libman-Sacks endocarditis. Mentioned below are a few of the treatment options that are being studied as of today.

• Anticoagulation therapy.

• Warfarin therapy with an INR (international normalized ratio) goal of two or three.

• Surgical interventions.

• Open heart surgery.

• Mechanical valve insertion.

• Bioprosthetic valve repair.

• Mitral clip.

• Balloon valvuloplasty.

• Transcatheter aortic valve replacement or TAVR.

• Transcatheter Mitral Valve Replacement or TMVR.

• Vegetative excision.

• Valve replacement.

• Prevention of recurrent embolization.

Conclusion:

Libman-Sacks endocarditis is a kind of NBTE- nonbacterial thrombotic endocarditis that develops a sterile vegetative growth on the surface of the cardiac valves which are small particulate or microscopic in size to large and visible growths. The clinical signs and symptoms of Libman-Sacks endocarditis are parallel to the underlying medical conditions, especially cardiovascular conditions. There are several ways to diagnose Libman-Sacks endocarditis but the nature of the condition is such that there has not been any permanent and established treatment modality yet for Libman-Sacks endocarditis.