Endocarditis

Endocarditis is a bacterial or fungal inflammation of the inner layer of the heart, the endocardium, resulting in the formation of an adherent mass of thromboitic debris and organisms, termed as vegetation. It normally involves the coronary heart valves, the interventricular septum, the mural endocardium, cordae tendineae or the surfaces of the intracardiac gadgets. It's miles continually a severe infection and, if left untreated, will result in demise.

What Causes Endocarditis?

Predisposing factors

• Congenital heart disease: Such as bicuspid aortic valve, hypertrophic subaortic stenosis, calcified aortic valve disease, VSD, coarctation of aorta or patent ductus arteriosus
• Rheumatic Coronary disease: So as of sequence mitral regurgitation, mitral stenosis, aortic stenosis, aortic regurgitation
• Prosthetic valves

Organisms

• Enterococcus fecalis is found in perianal and fecal bacterial flora. It can cause infections more commonly in older men with the prostatic disease while in women with genitourinary infections.
• Staphylococcus aureus is responsible for acute endocarditis and originates from skin infections, abscesses or intravenous lines.
• Streptococcus viridians are a common cause of periodontal infections and are commensals in the upper respiratory tract. They may enter the blood stream on chewing, teeth brushing, or dental extraction.
• Postoperative endocarditis follows cardiac surgery and affects native or prosthetic valve. The most common organism is Staphylococcus epidermis.
• Fungal infections ( Aspergillus, Candida ) may attack previously normal or prosthetic valves, usually affects drug addicts and immunosuppressed patients.

Types of Endocarditis

   There are several ways to classify endocarditis. The simplest classification is based on the cause: either infective or non-infective, depending on whether the microorganism is the source of inflammation or not. The infective endocarditis is further subdivided into following subtypes:

Acute infective endocarditis

A highly virulent organism such as Staphylococcus aureus is responsible for causing an acute infective endocarditis. They can cause severe destruction of valve resulting in acute valvular regurgitation. Intravenous drug users are at very risk of endocarditis because numerous needle punctures give aggressive staph bacteria many opportunities to enter. If untreated this form of endocarditis can be fatal in less than six weeks.

Subacute infective endocarditis

Subacute infective endocarditis is caused by organisms of low virulence such as Streptococcus viridian and Streptococcus epidermidis that normally live in mouth and throat and almost always occur in patients with a pre-existing valvular abnormality. This condition has more chronic course, the resultant infection tends to progress somewhat more slowly and it usually is less likely to cause septic emboli than acute endocarditis. If untreated, it can worsen for as long as one year before it is fatal. 

Prosthetic Endocarditis

Prosthetic endocarditis is a serious infection with potentially fatal consequences, it can arise early or late after surgery. The timing of the infection reflects a different pathogenic mechanism that, in turn, influence the pathology and clinical manifestation of the infection. The common organism responsible for the prosthetic endocarditis is Staphylococcus epidermidis. This produces myocardial abscesses and damage to the conduction system.

Medical features of infective endocarditis 

• Features of contamination: Fever, night time sweats, fatigue, arthralgia, myalgia, weight reduction.
• Cardiac capabilities: Signs and symptoms of an underlying heart ailment, a cardiac failure because of valvular destruction, new or converting murmur.
• Functions of embolism: First time may additionally gift with embolic functions including stroke, pulmonary or myocardial infarction, extreme limb ache.
• Functions of immune vasculitis: Splinter hemorrhage, petechial hemorrhage, clubbing, janeway lesion.

Inspections of infective endocarditis

Following are a number of the powerful investigations to diagnose infective endocarditis:

1. Blood culture: It's far positive in approximately 95% of instances and negative in 5% cases.
2. ECG: This will display myocardial infarction or conduction defects,
3. Echocardiography: Is the important thing research for the detection of vegetations, valve harm, and the abscess formation.
4. Chest X-ray: This can indicate cardiac failure or pulmonary embolism in right-sided failure.
5. Serological assessments: It may include tests for immune complexes. 
6. Urine evaluation: Proteinuria may also occur and microscopic hematuria is constantly gifted.