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Endocarditis

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  • Endocarditis

    Endocarditis is a rare and potentially fatal type of heart infection. It is an infection of the inner lining of heart (endocardium). Endocarditis is uncommon in people with healthy hearts. People at greatest risk of endocarditis have damaged heart valves, artificial heart valves or other heart defects.

    Endocarditis generally occurs when bacteria or other germs from another part of body, such as mouth, spread through bloodstream and attach to damaged areas in heart. Left untreated, endocarditis can damage or destroy heart valves and can lead to life-threatening complications.

  • Endocarditis

    Symptoms:

    • Small areas of bleeding under the nails
    • Red, painless skin spots on the palms and soles
    • Red, painful nodes in the pads of the fingers and toes
    • Shortness of breath with activity
    • Swelling of feet, legs, abdomen
    • Fever, chills, and sweating are frequent symptoms.
  • Endocarditis

    Diagnostic test:

    • Blood culture to help identify the bacteria or fungus that is causing the infection
    • Complete blood count (CBC), C-reactive protein (CRP), or erythrocyte sedimentation rate (ESR)
    • A routine echocardiogram or a transesophageal echocardiogram to look at the heart valves
  • Endocarditis

    Treatment:

    Long-term antibiotic therapy:

    • People most often need therapy for 4 to 6 weeks to fully kill all the bacteria from the heart chambers and valves.
    • Antibiotic treatments that are started in the hospital will need to be continued at home.

    Surgery to replace the heart valve is usually needed when:

    • The infection is breaking off in little pieces, resulting in strokes.
    • The person develops heart failure as a result of damaged heart valves. • There is evidence of more severe organ damage.
  • Endocarditis

    Statistics:

    Recent studies have shown that the annual incidence of infective endocarditis (IE) is stable between 15 and 60 cases per million.The annual age- and sex-standardized incidence was 31 cases per million. There was no previously known heart disease in 47% of the cases. The proportion of prosthetic-valve IE was 16%. Causative microorganisms were: streptococci, 48%; enterococci, 8%; Abiotrophia species, 2%; staphylococci, 29%; and other or multiple pathogens, 8%. Blood cultures were negative in 9% and no microorganism was identified in 5% of the cases. In hospital mortality was 16%. Compared with 1991, this study showed a decreased incidence of IE in patients with previously known underlying heart disease (20.6 cases per million vs 15.1 cases per million; P<.001); a smaller incidence of oral streptococcal IE (7.8 cases per million vs 5.1 cases per million; P<.001), compensated by a larger proportion of IE due to group D streptococci (5.3 cases per million vs 6.2 cases per million; P = .67) and staphylococci (4.9 cases per million vs 5.7 cases per million; P = .97); an increased rate of early valve surgery (31.2% vs 49.7%; P<.001); and a decreased in-hospital mortality rate (21.6% vs 16.6%; P = .08). Although the incidence of IE has not changed, important changes in disease characteristics, treatment, and outcomes were noted.

 

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