Endocarditis

Endocarditis is a relatively uncommon but very serious infection of endocardium, the inner lining of the heart, which usually leads to formation of vegetations, clusters of microorganisms, fibrin and platelets attached to heart valves.

People at risk

Heart is normally quite resistant against infection but a previous damage to the valves, presence of artificial valves, congenital heart disease or intravenous drugs addiction can make it easier for the pathogenic bacteria to invade endocardium. Even in people at risk, endocarditis is not a common disease; around one person out of 3,000 gets endocarditis annually in England.

Signs and complications

The early signs of endocarditis are similar to the flu and include fever, chills, headache, chills, loss of appetite and joint pain.

Endocarditis can damage the heart valves and lead to valvular regurgitation (some of the blood returns to the previous heart chamber against the normal direction of circulation), abscess formation (collection of pus inside the heart muscle), embolization (dissemination of infected material around the body, leading to interruption of blood supply e.g. to brain causing stroke, gut and kidneys).

Treatment

The cornerstone of treatment of endocarditis are intravenous antibiotics (given as a drip) for several weeks. A substantial proportion of patients will require surgery to replace damaged heart valve (e.g. aortic valve replacement, AVR, in case of infected aortic valve) and remove absesses. Despite advances in medicine the incidence of endocarditis is not declining due to more accurate diagnostics (availability of transoesophageal echocardiography,TOE) and increasing numbers of people at risk after valve replacement, repair of congenital heart disease or substance misuse.

Prognosis

Endocarditis remains a serious disease and despite modern medical care the mortality is about 20% (1 person out of 5 die of the condition).

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