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CARDIOVASCULAR INFECTIONS
CONTENTS
OVERVIEW
The heart has four valves - one for each chamber of the heart. The valves keep blood moving through the heart in the right direction. In heart valve disease, one or more of the valves in your heart does not work properly; the valves do not open or close properly. This can cause the blood flow through your heart to your body to be disrupted.
The mitral valve and tricuspid valve are located between the atria (upper heart chambers) and the ventricles (lower heart chambers).
The aortic valve and pulmonic valve are located between the ventricles and the major blood vessels leaving the heart.
WHAT IS INFECTIVE ENDOCARDITIS?
Infective endocarditis is an infection in the heart valves or endocardium. The endocardium is the lining of the interior surfaces of the chambers of the heart. This condition is usually caused by bacteria entering the bloodstream and infecting the heart. Bacteria may originate in the:
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mouth
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skin
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intestines
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respiratory system
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urinary tract
When this condition is caused by bacteria, it is also known as bacterial endocarditis. In rare cases, it can also be caused by fungi or other microorganisms.
Infective endocarditis is a serious condition that requires prompt medical treatment. If left untreated, the infection can damage your heart valves. This can lead to problems including:
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stroke
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damage to other organs
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heart failure
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death
This condition is rare in people with healthy hearts. People who have other heart conditions are at higher risk.
You may need to take antibiotics before certain medical and dental procedures if you are at high risk for infective endocarditis. Antibiotics help stop bacteria from entering your bloodstream and causing infection. Engage in a conversation about antibiotics with your surgeon or dentist before any surgical procedure.
SYMPTOMS OF INFECTIVE ENDOCARDITIS
Symptoms vary from person to person. In some people, symptoms come on suddenly, while others develop symptoms more slowly. Talk to your doctor if you experience any of the symptoms listed below. People at high risk of endocarditis should take particular care.
Symptoms may include:
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fever
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chest pain
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weakness
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blood in urine
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chills
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sweating
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red skin rash
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white spots in the mouth or on the tongue
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pain and swelling in joints
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muscle aches and tenderness
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abnormal urine color
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fatigue
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cough
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shortness of breath
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sore throat
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sinus congestion and headache
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nausea or vomiting
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weight loss
Infective endocarditis can be life-threatening if not treated promptly. Unfortunately, signs of infective endocarditis can resemble many other illnesses. Please call our office or your doctor immediately if you experience any of the symptoms listed above.
CAUSES
Endocarditis occurs when germs, usually bacteria, enter your bloodstream, travel to your heart, and attach to abnormal heart valves or damaged heart tissue. Fungi or other germs also may cause endocarditis.
Usually, your immune system destroys any harmful bacteria that enter your bloodstream. However, bacteria that live in your mouth, throat, or other parts of your body, such as your skin or your gut, can sometimes cause endocarditis under the right circumstances.
Bacteria, fungi, and other germs that cause endocarditis might enter your bloodstream through:
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Improper dental care. Proper toothbrushing and flossing help prevent gum disease. If you do not take good care of your teeth and gums, brushing could cause unhealthy gums to bleed, giving bacteria a chance to enter your bloodstream. Some dental procedures that can cut your gums also may allow bacteria to enter your bloodstream.
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Catheters. Bacteria can enter your body through a thin tube that doctors sometimes use to inject or remove fluid from the body (catheter). This is more likely to occur if the catheter is in place for a long period of time. For example, you may have a catheter if you need long-term dialysis.
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Illegal IV drug use. Contaminated needles and syringes are a special concern for people who use illegal IV drugs, such as heroin or cocaine. Often, individuals who use these types of drugs don't have access to clean, unused needles or syringes.
INFECTIVE ENDOCARDITIS RISK FACTORS
You may be at risk for this condition if you have:
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artificial heart valves
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congenital heart disease
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heart valve disease
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damaged heart valves
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hypertrophic cardiomyopathy
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a history of endocarditis
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history of illegal drug use
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mitral valve prolapse and valve regurgitation (leaking) and/or thickened valve leaflets
The risk of infective endocarditis is higher after procedures that allow bacteria access to the bloodstream. These include:
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dental procedures involving the gums.
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insertion of catheters or needles
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procedures to treat infections.
These procedures do not put most healthy people at risk. However, people who have one or more risk factors for infective endocarditis need to be more careful. If you need one of these procedures, talk to your doctor first. You may be put on antibiotics before your visit.
When you visit your doctor, you will first be asked to describe your symptoms. Your doctor will then perform a physical examination. They will listen to your heart with a stethoscope and check for sounds of a murmur, which may be present with infective endocarditis. Your doctor may also check for a fever and feel for an enlarged spleen by pressing on your left upper abdomen.
If our specialists suspect infective endocarditis, your blood will be tested for bacteria. A complete blood count (CBC) may also be used to check for anemia. A shortage of red blood cells can occur with infective endocarditis.
Our specialists may order a transesophageal echocardiogram (TEE) echocardiogram, or an ultrasound of the heart, wherein a smaller device is threaded down your throat and into your esophagus. This offers a more detailed image. The echocardiogram shows how blood flows through your heart’s valves. It looks for damaged tissue, holes, or other structural changes in your heart valve.
Our specialists may also order an electrocardiogram (EKG). An EKG monitors electrical activity in your heart. This painless test can find an irregular heartbeat caused by endocarditis.
Imaging tests can check if your heart has enlarged. They may also be able to
detect signs that infection has spread to other areas of your body. Such tests include:
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chest X-ray
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computed tomography (CT) scan
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magnetic resonance imaging (MRI)
If you’re diagnosed with infective endocarditis, you will be immediately admitted to the hospital for treatment.
TREATMENT
Infective endocarditis can cause irreversible damage to the heart. If it’s not caught and treated quickly, it can become life-threatening. You will need to be treated in a hospital to prevent the infection from getting worse and causing complications.
Antibiotics and initial treatment
While in the hospital, your vital signs will be monitored. You will be given antibiotics intravenously (IV). Once you go home, you will continue with oral or IV antibiotics for at least four weeks. During this time, you will keep visiting your doctor. Regular blood tests will check that the infection is going away.
Surgery
Surgery may be needed if your heart valves have been damaged. Your surgeon may recommend repairing the heart valve. The valve can also be replaced using a new valve made from either animal tissue or artificial materials.
Surgery may also be necessary if the antibiotics are not working or if the infection is fungal. Antifungal medications are not always effective for infections in the heart.
RECOVERY AND OUTLOOK
If left untreated, this condition will be fatal. However, most people are able to recover with antibiotic treatment. The chance of recovery depends on factors including your age and the cause of your infection. In addition, patients who get prompt treatment have a better chance of making a full recovery.
It may take you longer to recover completely if surgery was necessary.
AORTITIS
OVERVIEW
Aortitis encompasses all conditions, infectious or non-infectious, leading to different types of inflammation of the aortic wall.
The aorta, the main and largest artery in the human body, is a tube-like structure, usually about 1 inch wide in diameter, although its size varies proportionally to the height and weight of the person and it carries blood away from your heart to the rest of your body.
After the blood leaves the heart through the aortic valve, it travels through the aorta, making a cane-shaped curve that connects with other major arteries to deliver oxygen-rich blood to the brain, muscles, and other cells.
WHAT ARE THE SYMPTOMS OF AORTITIS?
Symptoms of aortitis depend on the underlying condition causing the inflammation, and in the early stages, there may be no symptoms at all. Sometimes the aortic inflammation is discovered only at the time of surgery for an aneurysm.
General symptoms may include:
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Severe headaches that do not go away.
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Back pain
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Chest pain
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Abdominal pain
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Fever
WHAT CAUSES AORTITIS?
When the aortitis is associated with an underlying condition such as vasculitis or other rheumatic disorder, symptoms include:
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Headaches
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Tenderness of the scalp, especially the temples
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Fatigue
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Fever
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Pain and weakness of the arms and legs
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Chest pain
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Shortness of breath
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Loss of vision/double vision
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Unexplained weight loss
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Dizziness/fainting
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Difficulty with coordination and balance
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Night sweats
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Joint and/or muscle pain
The causes of aortic inflammation can be divided into three categories:
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Noninfectious: Caused by an underlying rheumatic disease—an umbrella term for inflammatory disorders that cause chronic pain of the joints, muscles, and connective tissue. Some forms of vasculitis fall into this category, including giant cell arteritis (GCA) and Takayasu’s arteritis, Behcet’s syndrome, and Cogan’s syndrome. Other inflammatory disorders that can affect the aorta include systemic lupus erythematosus, rheumatoid arthritis, ankylosing spondylitis, sarcoidosis, and others.
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The causes of aortic inflammation can be divided into three categories:
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Noninfectious: Caused by an underlying rheumatic disease—an umbrella term for inflammatory disorders that cause chronic pain of the joints, muscles, and connective tissue. Some forms of vasculitis fall into this category, including giant cell arteritis (GCA) and Takayasu’s arteritis, Behcet’s syndrome, and Cogan’s syndrome. Other inflammatory disorders that can affect the aorta include systemic lupus erythematosus, rheumatoid arthritis, ankylosing spondylitis, sarcoidosis, and others.
COMPLICATIONS DUE TO AORTITIS
Inflammation of the aorta and its major arteries can lead to kidney failure, aortic aneurysm, stroke, heart failure, and heart attack. In cases where there is an underlying disease or infection causing the aortitis, complications are related to the specific cause.
DIAGNOSING AORTITIS
In diagnosing aortitis, your doctor will consider a number of factors, including a detailed medical history; physical examination; laboratory tests; and specialized imaging studies. A physical exam may reveal abnormal heart sounds, and/or sounds over the major arteries; abnormalities (discrepancy) of blood pressure; difference in blood pressure between the arms and legs; or reduced or absent pulse in the wrists or ankles.
Determining the cause of the aortitis is critically important because the treatments vary depending on the source of the inflammation. For example, immunosuppressant medications typically used to treat vasculitis are not appropriate for aortitis caused by infection, as they can aggravate an active infection. Diagnosis of isolated aortitis involves ruling out diseases or conditions that can cause aortic inflammation and present with similar symptoms.
Depending on the organs affected, the following diagnostic tests may be ordered:
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Blood tests: To detect abnormal levels of antibodies and proteins in the blood, which can indicate inflammation or infection. People with inflammation typically have elevated levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR, or “sed rate).
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Imaging tests: Echocardiogram uses ultrasound waves to examine the heart. Other tests include computed tomographic angiography (CTA), and magnetic resonance angiography (MRA), which reveal abnormalities of the aorta such as aneurysms or narrowing of the vessels. A dye-based angiography is rarely needed for diagnosis.
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Tissue biopsy: A biopsy involves surgical removal of tissue from an affected vessel, which is sent to a laboratory and analyzed for signs of inflammation. Biopsy of the aorta is not possible unless a surgical procedure is needed for an aortic aneurysm.
TREATMENT OF AORTITIS
The course of treatment for aortitis treatment depends on what is causing the inflammation. While infectious aortitis is rare, it can be life-threatening and requires prompt treatment with appropriate antibiotics, sometimes given intravenously.
In cases of isolated aortitis, and aortitis associated with systemic vasculitis or other autoimmune disorders, treatment is aimed at controlling the inflammation, typically with corticosteroids. Other treatments may include immunosuppressant drugs. Biologic agents as may be prescribed. Biologic medications are complex proteins derived from living organisms. They target certain parts of the immune system to control inflammation.
Surgery is sometimes needed to repair an aneurysm or to bypass blocked arteries.
OUTLOOK
Aortitis is a serious condition. The outlook for patients with this condition depends on whether the aortitis is caused by an infection or another underlying condition, and also how quickly the disease is diagnosed and treated. Patients with aortitis may experience relapse of their vasculitis symptoms. Aortitis requires ongoing medical care and repeated imaging studies of the heart and aorta.