Endocarditis

(Acute and subacute bacterial endocarditis, non-bacterial thrombotic endocarditis)

Endocarditis is an inflammation or infection of the endocardium, the inner lining of the heart valves and chambers, and most often occurs in the valves.

In the past, this condition was often a consequence of rheumatic fever, a childhood infection, but this is no longer true because strep throat -- an infection that can lead to rheumatic fever -- is now I quickly detected and treated.

Although anyone can develop endocarditis under certain circumstances, today it is most prevalent among intravenous drug abusers and people who have valvular heart disease, especially those with artificial heart valves or certain types of congenital birth defects.

The infection develops when bacteria have an opportunity to invade the bloodstream, for example, during dental procedures or surgery, especially colon, urologic. or gynecologic operations. Skin infections also increase the risk.

Symptoms suggesting endocarditis include a persistent low-grade fever, shortness of breath, increasing weakness, night sweats, joint pain, general malaise, and the appearance of tiny purple spots, or petechia, on the chest, fingers, toes, or in the mouth.

Diagnostic Studies and Procedures

The initial diagnosis is generally made on the basis of medical history and symptoms, and by listening to the sounds of the heart. Subacute endcarditis, which causes only mild symptoms, can be difficult to detect, but development of a new heart murmur raises suspicion of the disorder. The eyes may also show small hemorrhages in the mucous membranes.

To confirm the diagnosis, a blood sample will be cultured to look for the presence of bacteria. An echocardiogram, or ultrasound imaging of the heart, may also reveal clumps of bacteria on the heart valves.

Medical Treatments

The mainstay of treatment is intensive antibiotic therapy, which is usually given intravenously in a hospital After the initial crisis is past, oral antibiotics can be substituted for the intravenous drugs, but the therapy is usually continued for at least a month or longer.

In a few cases, surgery may be necessary to remove infected areas or repair or replace a damaged heart valve. The one that most often needs replacing is the mitral valve, which regulates the flow of newly oxygenated blood from the left atrium to the left ventricle, the heart's main pumping chamber.

Alternative Therapies

There are no alternative therapies that can substitute for antibiotic treatment in clearing up endocarditis, although some can serve as adjuncts to regular medical treatment.

Exercise. Even while bedridden, you can do certain exercises to prevent clot formation. Ask your doctor about a safe regimen that will help maintain good circulation and muscle tone without straining your heart.

Herbal Medicine. Two garlic capsules daily are recommended to protect the heart against infection.

Massage. During recovery, massage of the legs can be helpful in preventing, blood clots from forming.

Naturopathy and Nutrition Therapy. Extra vitamin C is recommended by some nutritionists to strengthen the immune system and protect against infection. Naturopaths also suggest a daily helping of onions to help prevent all forms of heart disease.

Self-Treatment

If you are at risk for developing endocarditis, you should make sure that all health professionals whom you see know that you have this underlying heart problem. They can then prescribe preventive antibiotics before any procedure that increases your chances for infection. For example, a dentist might a give you a high dose of penicillin or similar antibiotic before an extraction or cleaning your teeth, to kill any bacteria that may enter the bloodstream through cuts around your gums. People who have had rheumatic fever or who have an artificial heart valve in place may be advised to take antibiotics daily for life, especially if they have had a prior episode of endocarditis.

Anyone addicted to illegal intravenous drugs such as heroin should enter a drug treatment program.

Other Causes of Endocarditis Symptoms

Many of the symptoms of endocarditis are sometimes confused initially with heart valve disease or flu and other infectious diseases.