Endocarditis, heart inflammation
Endocarditis is the term used to refer to inflammations of the heart's lining. The word derives from the Greek terms "endo" for inside and "kardia" for heart. Other names are endocarditis or heart inflammation. Endocarditis has a number of different causes. Regardless of the cause, they have one thing in common: without timely treatment, they are deadly. Healthy people have a very low risk of endocarditis. The most common are inflammations of the heart insides after heart disease or in humans with congenital heart defects and / or heart valve replacement.
In principle, bacterial endocarditis is easy to treat with antibiotics. This presupposes, however, that the heart inflammation is diagnosed at all. This is not always easy because of the mostly unspecific symptoms at the beginning of the disease. The later an endocarditis is detected, the greater the risk of life-threatening complications such as stroke, pulmonary embolism or brain embolism. Untreated, endocarditis is almost always fatal.
Another challenge in the treatment of endocarditis is multidrug-resistant bacteria. In clinical practice, the number of cases in which the causative bacteria can no longer be combated with antibiotics has increased in recent years.
The frequency of endocarditis in Germany is not easy to determine. Experts assume that per 100,000 inhabitants and year up to 6 people first contract endocarditis. On 82 million Germans therefore come about 5,000 new cases of inflammation of the heart. Most cases occur until the age of 50. Thereafter, the risk of endocarditis in healthy people decreases significantly.
The first symptoms of acute endocarditis are fever episodes (sometimes with chills), newly occurring heart sounds and accelerations of the heartbeat (tachycardia) and water retention in the legs (edema), cold feelings and nocturnal sweating. Fatigue, loss of appetite, weight loss and muscle or joint pain are other early symptoms of endocarditis. These symptoms occur in a variety of diseases. Therefore, heart inflammation in the medical practice are sometimes detected late.
As you progress, the symptoms of endocarditis become more specific. In up to 15 percent of the cases there are skin lesions. These include small punctate skin bleeding (petechiae), lentil-red nodules on the fingers and toes (Osler nodules) and reddish, just a few millimeters large patches on the palms and soles of the feet (Janeway lesions).
As endocarditis progresses, signs of diminishing cardiac or valve function increase. These include, for example, anemia, shortness of breath, upper abdominal complaints with enlargement of the liver and spleen swelling, as well as extensive water retention (edema) in the tissue.
Due to the inflammation, changes in the tissue structure occur on the inner lining of the heart. If parts of these growths enter the vascular system with the bloodstream, the risk of vascular occlusions resulting in strokes and lung or kidney embolisms increases. In addition, the bacteria in other organs can lead to the formation of abscesses or even cause blood poisoning (sepsis).
The cause of endocarditis is an infection that is almost always caused by bacteria. Most of these are brucella bacteria, streptococci, staphylococci or enterococci. In Germany, every second case of endocarditis is now caused by the multidrug-resistant bacterium Staphylococcus aureus. Other causative agents of heart inflammation are viruses and fungi. In addition, there are noninfectious endocarditis through autoimmune processes.
In bacterial endocarditis, the bacteria attach themselves to the lining of the heart of the heart or close to the blood vessels and cause an inflammatory reaction. Without early treatment, the inflammation spreads to the heart valves, which are also lined with heart tissue. The bacterial infection and the reactions of the immune system to it change the tissue of the heart's lining. There are small growths. This has, among other things, three consequences.
- On the one hand, the finely balanced interaction of the heart valves is disturbed, which reduces cardiac output. The heart tries to compensate for this weakness by pumping harder. As a result, the heart muscle thickening continues, which ultimately leads to heart failure.
- On the other hand, there is a risk that parts of the tissue proliferations get into the bloodstream. There they can settle in containers and close them. This often causes strokes or pulmonary or renal emboli.
- As the bacteria spread further along the bloodstream, the risk of sepsis increases.
How do bacteria get into the heart?
Most commonly, bacteria enter the heart through surgical procedures and bacterial respiratory infections. Surgical interventions include large and small operations of the heart. But even a simple dental or orthodontic surgery can form the gateway for the bacteria. Even when brushing, bacteria can reach the heart through the slightest damage to the gums or oral mucosa. Typical bacterial infections as the starting point of endocarditis are pneumonia, bronchitis or even bacterial urinary tract infections. Another portal of entry is unclean injection punctures. In particular, therefore, inflammation of the heart inflammation occurs in drug addicts.
In healthy people, bacteria in the heart usually do no harm, but they are turned off by the immune system. The situation is different in people with diseases or malformations of the heart. In these cases, the bacteria often find the smallest attack surfaces such as microscopic injuries in which they can attach and multiply. This applies, for example, to people who have already undergone heart surgery or to congenital heart defects and heart valve replacement.
The diagnosis of endocarditis in otherwise healthy people is not always as fast as possible, because the early symptoms (see symptoms) may indicate a variety of diseases. In addition, inflammation of the inner skin is very rare in people without pre-existing heart disease.
In the vast majority of cases, people with endocarditis are at risk groups, which are usually in cardiac treatment for a long time. In these cases, the specialists know about the risk of heart inflammation and also about how the warning signs are to be interpreted. Patients with rheumatic disorders are more likely to be endocarditised. There, the disease sometimes occurs as a complication of rheumatic fever.
With an echocardiogram, the diagnosis of endocarditis can not always be reliably confirmed. The ECG can remain unremarkable. On the other hand, laboratory diagnostic evidence of bacteria from a blood sample provides certainty.
The therapy of heart inflammation depends on the cause. In mild cases or if the endocarditis has not caused any serious tissue damage, treatment with antibiotics may be sufficient. Antibiotics are also commonly used in viral heart inflammation in order to avoid superinfections. In about one third of the cases affected people do not respond to the drug therapy of endocarditis.
In these cases, as well as congenital heart defects, damage to the heart valves or extensive tissue damage surgery is inevitable.
The cure for endocarditis depends very much on the cause. If diagnosed in time, 3 out of 4 sufferers will survive acute bacterial endocarditis. Particularly at risk are people in whom the heart is inflamed in the area of artificial heart valves. If endocarditis causes heart failure, the survival rate also drops significantly.
In addition, mortality from bacterial endocarditis has been on the rise again for several years as a result of antibiotic resistance.
In the rare cases of endocarditis caused by fungi, up to 80 percent of those affected die.
Lack of oral hygiene and dental procedures are among the major causes of endocarditis. Therefore, the guidelines for at-risk groups recommend antibiotic endocarditis prophylaxis before dental or professional teeth cleaning (scaling removal). The risk groups include people:
- with severe congenital heart defects
- who have a heart valve surgery behind them
- have developed heart valve disease after a heart transplant
- have ever had endocarditis.
Basically, a thorough dental hygiene and regular dental visits are considered an important element of the prevention of heart inflammation.