Endocarditis

Endocarditis is relatively uncommon but very serious infection of the inner lining of the heart called endocardium. Endocarditis is usually caused by a blood borne infection.

People at risk

Heart is normally quite resistant against infection but a previous damage to the heart valves, presence of artificial valves, congenital heart disease or intraveinous drugs use can make it easier for the bacteria to take root. Even in people at risk, endocarditis is not a common disease; around 1 person out of 3000 gets endocarditis annually in England.

Signs and complications of endocarditis

The early signs of endocarditis are similar to the flu and include:

High grade fever (above 38 ÂșC), 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 body, leading to interruption of blood supply eg to brain (causing stroke), gut and kidneys.

Treatment of endocarditis

The cornerstone of treatment of endocarditis are intraveinous antibiotics (given as a drip) for several weeks under hospital admission. A substantial proportion of patients will require surgery to replace damaged heart valve (eg aortic valve replacemnt, 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).