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Endocarditis is the inflammation of the endocardium layer of the heart.
It is caused by a bacterial or, rarely a fungal infection. Endocarditis mainly affects the heart valves, but it can affect the:
interventricular septum: this separates the right and left ventricles (perforation) chordae tendineae: fibrous cords of tendons that connect papillary muscle to the tricuspid and bicuspid valves (rupture)
Types of Endocarditis:
Infective: bacteria, virus, or fungi gets into the bloodstream and grows on the valve. The heart valves are more susceptible (especially defected heart valves) to this because they don’t have a blood supply to help fight off infection (hence, white blood cells). Therefore, the body doesn’t fight it properly. Non-infective: sterile platelets and fibrin (thrombus) form on the valve due to trauma or some other issue (hypercoagulated blood) but it isn’t pathogenic. However, it is a site of origin for possible infective endocarditis.
Infective endocarditis is a microbial infection of the endothelial surface of the heart. It
usually develops in people with prosthetic heart valves, cardiac devices (e.g., pacemaker), or structural cardiac defects (e.g., valve disorders, HCM) (see Chart 28-4). It is more common in older adults (Josephson, 2014), who are more likely to have degenerative or calcific valve lesions, reduced immunologic response to infection, and metabolic alterations associated with aging. Staphylococcal endocarditis infections of valves in the right side of the heart are common among IV drug abusers. Hospital-acquired infective endocarditis occurs most often in patients with debilitating disease or indwelling catheters and in patients who are receiving hemodialysis or prolonged IV fluid or antibiotic therapy. Patients taking immunosuppressive medications or corticosteroids are more susceptible to fungal endocarditis
Type of Infective Endocarditis:
Acute IE: affects patient who have healthy heart valves (high death rate). The onset is fast and symptoms are very severe. Subacute IE: affects people who have a pre-existing condition like rheumatic heart disease, valve problem. The symptoms are subtle and onset slower (several weeks to months to develop).
World Statistics
Infective endocarditis (IE) is still considered to be an infrequent but fatal and debilitating disease if left untreated. It is estimated that IE affects 3–7.5 people per 100,000 person-years and its incidence is reported to be increasing in some parts of the world. IE incidence appears to vary significantly as reported from different geographic areas even within the same country. IE is a disabling and lethal disease with an overall mean proportion of IE-related stroke of 15.8% ± 9.1%, a mean proportion of patients that have undergone valve surgery of 32.4% ± 18.8%, and a mean case fatality risk of 21.1% ± 10.4%. IE incidence remains largely unknown from many parts of the world due to a paucity of data from several countries. Intravenous drug use, advanced age, intracardiac electronic devices, degenerative valvular heart disease, cardiac transplant with development of valvulopathy, haemodialysis, HIV infection, and diabetes mellitus are among the new emerging risk factors that have recently been shown to be implicated more frequently than the traditional risk factors in IE development. Staphylococcus aureus is the leading cause of IE worldwide and has taken predominance over viridans group streptococci in many parts of the world. Globally, IE is associated with a significant burden and was responsible for 45,000 deaths in 1990 and 65,000 deaths in 2013. The mortality rate from IE is significantly high, with an in-hospital mortality rate of up to 22% and a 5-year mortality rate of 45%.
