Endocarditis: How is it manifested, infectious, non-infectious or rheumatic? + Other forms and their causes

Endocarditis is an inflammatory disease of the inner lining of the heart or endocardium. In most cases, it is caused by an infectious origin. However, not always.

During the inflammatory process, the heart valves are mainly affected. Consequently, possible damage is valve damage and dysfunction.

Which also affects the activity of the heart. There is also a risk of heart failure.

Another complication is the risk of embolization of a blood clot from the heart to other parts of the body.

A brief look at the heart and endocardium

The heart is a pump that pumps blood to the whole body and thus ensures the survival of all cells.

The main working unit of the heart is the heart muscle. This is technically referred to as the myocardium. Surely you have already heard the term myocardial infarction or heart muscle.

In addition to muscle, the heart also has other layers, gradually:

• The pericardium is a pericardium, a kind of sac in which the whole heart is stored
• the epicardium, which is the membrane on the surface of the heart
• myocardium - the heart muscle is the largest layer of the heart
• endocardium - the inner layer of the heart that is in contact with the blood 
  • forms the heart valves
  • flows smoothly into the vessels
  • has 4 layers :
    • endothelium, composed of endothelial cells
    • subendothelium, which is a collagen ligament
    • elastic - muscular layer, composed of collagen, elastic tissue, and partly smooth muscle cells
    • the subendocardium is a sparse connective tissue, the structures of the cardiac transmission system are stored here

The endocardium has different thicknesses.
The coarsest is in the halls. 
And where big blood vessels leave the heart.

The valves have no vessels. Their nutrition occurs through diffusion, ie the transfer from the surrounding flowing blood. 

The presence of vessels in the endocardium of the valves is a sign of an ongoing pathological process. This is especially true in endocarditis.

The heart contains 4 cavities, which are called atria and ventricles. 
The right side of the heart has one atrium and one ventricle. 
Likewise, the left side also has an atrium and a ventricle.

Why is it important?

Blood from the body returns through large veins to the heart through the right atrium. It is deoxygenated blood, oxygen has been consumed in the body's cells. 

For life, the blood needs to be oxygenated again. Re-saturation of the blood with oxygen takes place in the lungs.

That's why we breathe to get oxygen to our lungs and blood.
And excess carbon dioxide from the lungs out.
Oxygen binds to hemoglobin in the lungs . 
Hemoglobin is a blood pigment that makes red blood cells.
1.34 milliliters of oxygen are bound per gram of hemoglobin . 

Blood from the right atrium moves to the right ventricle.
→ 
From the right ventricle then through the pulmonary artery to the lungs. 
→ 
In the lungs, the blood is enriched with oxygen. 
→ 
It is oxygenated.

+

From the lungs, blood moves to the left ventricle. 
→ It 
is then expelled from the left ventricle into the aorta → ie into the whole body.

Blood circulation = circulation is divided into :

1. small blood circulation = pulmonary blood circulation
2. large blood circulation = body blood circulation

All this requires a pump, the role of which is represented by the heart. 

Blood pumping is provided by 2 phases :

1. contraction of the heart = systole, the expulsion of blood from the heart cavities
2. diastole = relaxation of the heart muscle, sucking blood into the cavities

=

1. Systole - by gradually contracting the heart cavities, the blood moves further in the compartments of the heart to the lungs and back to the heart. Subsequently, from the heart to the aorta, ie the whole body.

2. Diastole - is the phase of release of cardiac compartments. Then the cavities of the heart are filled with blood.

Heart valves are important in this gradual expulsion and aspiration of blood. 

The flap is a non -return valve. When it is opened, the blood flows further. The pressure gradient at the heart stages closes it. This prevents the blood from flowing back to the previous parts of the heart.

If it is damaged, it performs this function imperfectly or not at all. This eventually leads to heart failure. 

For more information, see Heart Valve Disease. 

Want to know more about endocarditis ? 
What causes it? 
How does it manifest itself? 
Heal? 

What is endocarditis?

Inflammation of the inner lining of the heart is called endocarditis. In this case, it may be inflammation located on the inner wall of the heart.

However, it most often affects the endocardium  on heart valves .

As a result of the inflammatory process, the flap is damaged. This will cause a malfunction, leading to a possible risk of gradual heart failure.

Another complication of damage to the inner lining of the heart is:

The endocardium is in close contact with the flowing blood.

Inflammation damages the endocardium. A blood clot - a thrombus - begins to form at the site of the damaged lining, by attaching platelets.

In short, it is a risk factor for tearing off this precipitate.

The blood clot, still attached to the thrombus, is expelled by the heart into the great body circulation. At this time it is already an embolus.

Embolus = A blood clot, or foreign body, traveling in the blood vessels.

The embolus can clog a blood vessel anywhere in the body. Behind this blockage site, there is no blood flow, ie ischemia.

An example is a blockage of a vessel:

• heart = heart attack
• brain = stroke
• intestine = intestinal ischemia, vascular ileus
• kidney = bloodlessness and heart attack
• and other

Endocarditis as such occurs in several forms. It is divided accordingly.

The table lists the types of endocarditis

What is the cause of endocarditis?

In most cases, importance is attached to the infectious agent. But the infection is not the only reason. 

As can be seen in the previous table, endocardial inflammation is divided into several forms. And also according to the cause.

However.

It is basically damage to the endothelial layer. And the damage occurs on a variety of grounds. At the same time, a damaged valve is a risk for complications.

We report that a valve disruption is an option for the development of heart failure or embolization by a torn-off thrombus.

The birth of problems is supported by the deformation of the flap, and thus its function is impaired.

The destroyed valve changes the properties of the blood flow. Which promotes the formation of blood clots inside the heart.

Plus.

Blood that flows through an imperfectly closed valve overloads the heart. It accumulates where it does not, which results in enlargement or enlargement of the compartments of the heart. 

And this leads to a gradual failure of heart activity. The speed of the course depends on several factors.

A contributing factor for the already present valve disease or valve replacement for an artificial and congenital developmental heart disease.

What can be the origin of endocarditis?

Several factors may be involved in the development of endocado inflammation. From a broader perspective, it is divided into non - rheumatic and rheumatic endocarditis.

The table lists the causes of endocarditis

Some risk factors contributing to the possible development of endocarditis:

• non-bacterial thrombotic vegetation - thrombus on the endocardium when damaged
  • in degenerative valve changes - calcification
• the poor condition of teeth, tooth decay, inflammation in the oral cavity
  • but also during dental surgery, tooth extraction and mucosal damage in the oral cavity
  • especially in people with poor oral hygiene
• purulent tonsillitis
• liver cirrhosis
• alcoholism
• carcinoma
• diabetes mellitus - diabetes
• steroid treatment
• inflammatory bowel disease
• immune disorder
• drug addiction and vascular drug delivery
  • 12 times higher risk
  • mostly right-sided endocarditis
• systemic lupus
• dialysis patient
• burns
• polytrauma - injuries affecting several organs
• operations and medical procedures
  • especially long-term patients
  • people with previous endocarditis
  • intravenous approach to drug administration
  • also during tracheal intubation
  • gastroscopy
  • catheterization, cardiac procedures, and heart valve replacement
  • tonsillectomy - when removing tonsils
  • patients with a long-established urinary catheter
  • and other

Antibiotic prophylaxis is used in the presence of risk factors and in patients with a higher degree of risk. Thus, prevention of infectious endocarditis by administering antibiotics before or after procedures.

Endocarditis can be manifested by several difficulties. The infection will be accompanied by an increase in body temperature to fever. On the contrary, the non-infectious form does not.

The basic general manifestations of the disease include:

• general symptoms as in influenza
• fatigue
• overall weakness
• malaise
• exhaustion
• performance reduction
• difficulties exacerbated by exertion
• anorexia and nausea
• weight loss
• pallor
• joint and muscle pain
• palpitations and tachycardia (fast heart beat)
• chest pain
• difficulty breathing
• night sweats
• increase in body temperature to fever during infection
• dizziness
• the feeling of falling off to syncope, collapse
• swelling of the lower limbs, later progressing higher
• heart murmur
• various complications

Plus.

In non-infectious endocarditis, the thrombus present may not cause any significant problems. However, this is until it breaks away and travels through the vessels like an embolus.

Consequently, it causes difficulties depending on where it caused the embolism, ie clogging of the vessel and ischemia. For example, when the blood vessels become clogged, it will be a heart attack and in the case of cerebral arteries, there will be a stroke.

Diagnosis is based on the anamnesis, clinical symptoms, ie according to how the disease manifests itself.

Of course, other examinations are also necessary.

It is important for laboratory blood tests, such as blood counts, blood culture, erythrocyte sedimentation rate, and CRP. To detect an infectious agent.

After all, the measurement of blood pressure and the examination of other physiological (vital) functions, such as pulse, respiration, blood oxygen saturation, are performed. An ECG is supplemented to monitor the activity of the arcade and the presence of an arrhythmia.

ECHO is of great importance in diagnostics.

ECHO = echocardiography - ultrasound examination of the heart.
In this examination, the heart,
its overall size,
dimensions of the cavities,
wall thickness, 
myocardium are evaluated. 
As well as the structure of the flaps. 
And other... 

Among other imaging methods, it is a chest X-ray.

The course of the disease depends on the form.

An example is acute infectious endocarditis, which develops from another inflammation in the body. Bacteria enter the heart through the bloodstream.

In the heart, they attach to the endocardial wall or valve. The most common is the aortic or mitral valve, less often the walls of the heart.

Aortic valve = valve between the left ventricle and the aorta. 
Mitral valve = valve between the left atrium and the left ventricle. 

Once trapped in the heart, they cause inflammatory damage that traps platelets, platelets, and fibrin. Along with the multiplication of bacteria, characteristic vegetation is created.

Vegetation = a cluster of bacteria on which platelets, fibrin, erythrocytes (red blood cells), inflammatory cells attach. 

The destruction and deformation of the valves are rapid, as is the escalation of the difficulties associated with infectious endocarditis.

The acute and progressive course is typical

Manifestations are high fevers, chest pain, difficulty breathing, and general manifestations of the inflammatory process. Such as weakness, joint pain, whole body, nausea, loss of appetite, and others.

At a later stage, if left untreated, there is a risk of heart failure, shock, or death.

The complication is the removal of vegetation from the valve, its expulsion into the body circulation. There is a risk of clogging of the vessel, ie embolization in another part of the body. An example is the mentioned heart or cerebral infarction, but also the formation of distant abscesses - inflammatory deposits.

Contributing factors are the present degenerative process on the valve, its damage, the presence of inflammation in the body, and reduced immunity.

The reversal of non-infectious endocarditis to infectious is also described.

The subacute form of infectious endocarditis is slower, not as acute. The development of difficulties is also milder.

Duration for months to years.

General symptoms such as fatigue, malaise, joint pain, fever, which may last longer, night sweats are typical. 

However, similarly, a possible risk complication is embolization by a clot in addition to the inflammatory process.

Rheumatic fever has been reported to be a major source of endocardial damage in the past. 

For other forms of endocarditis, the course varies depending on the primary disease.

+ risk association of problems across the whole human organism

Wall and valve vegetations can be infectious, but also non-infectious. In the non-infectious process, the damaged endocardial layer is covered with blood elements.

This also implies the possibility of the clot being released and expelled into the vascular bed.

And for example ...

A risk complication of right-sided endocarditis may be embolization into the pulmonary artery or lungs and their non-bleeding. Subsequently, it is pneumonia, ie pneumonia and the formation of abscesses - limited inflammatory deposits.

Right-handed = located in the right heart.

Generally.

In infectious endocarditis, it is possible for blood inflammation to spread to other areas of the body, such as:

• pericardium
• heart muscle
• brain
• pleura
• kidneys
• vessels
• and other

Heart problems stem from valve damage. Severe range causes dysfunction with the development of heart overload and failure. 

There is a risk of an aneurysm with aortic complications.