Endocarditis Causes and Treatment
Endocarditis is an inflammation of the valves or lining of the heart (endocardium), usually caused by a local bacterial infection. Endocarditis characteristically occurs where some structural abnormality, such as a congenital heart defect, produces a high-velocity blood flow through a narrow opening, such as a valve. The site of highest velocity immediately beyond the narrowing provides a special sanctuary in which bacteria can thrive, even though they may be destroyed in other areas of the body.
The bacteria causing endocarditis may enter the blood through infected tooth roots or intravenous injections with contaminated equipment, especially by drug addicts. Sometimes systemic, or generalized, infections become localized in the heart. Once infected, the area undergoes structural changes, including the deposition of blood clots and an ingrowth of connective tissue, resulting in a distortion that increases the velocity of the blood flow. The deposition of fibrin (the protein that forms the framework of a blood clot) or platelets on heart valve leaflets results in a partial backflow of blood through the valve.
Acute endocarditis starts abruptly and pursues a rapid course over a period of a few days or weeks. Subacute endocarditis develops more insidiously over a few months. In either case, the diagnosis of endocarditis is based on the finding of bacteria in the bloodstream and the detection of changing heart murmurs, indicating the progressive deformation of the infected area. Low fever, pallor, enlargement of the liver and spleen, and a tendency to tire easily are also observed. Changes that occur when blood clots and other bits of tissue from the infected site are swept into smaller vessels produce symptoms that also point to the diagnosis.
The treatment of endocarditis includes determining the type of bacterium causing the infection, establishing which antibiotic will kill it, and then administering the antibiotic in doses sufficient to eradicate the infection. Damage to a heart valve may persist and ultimately lead to a failure of the heart's pumping action. Surgical replacement of the affected valve may then be necessary.
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