Infective endocarditis is an infectious disease that causes inflammation of the heart valves and endocardium after pathogenic microorganisms, such as bacteria, have invaded the bloodstream. Bacteria grow and multiply on the heart valves, causing valve destruction and the formation of easily dislodged bulks that can lead to a range of heart and vascular problems. Studies have shown that the annual incidence of infective endocarditis is 2 to 6 per 100,000 people, with a morbidity and mortality rate of 16 to 25 percent. Therefore early prevention, diagnosis and proper management of infective endocarditis remains a daunting task.
Three groups of people are susceptible to the disease
People with underlying heart disease, such as congenital heart disease, rheumatic heart disease, or degenerative heart valve disease such as mitral valve prolapse.
2.People who have undergone heart valve replacement surgery or repair surgery for preexisting heart disease.
3.People who have a history of intravenous drug use.
Fever is the most basic manifestation
1.Fever, body temperature over 38℃. Patients feel chilly when the body temperature rises, taking antipyretic medicine is not effective, and the treatment is not good for a long time.
2.People with congenital heart disease, rheumatic heart disease or history of heart surgery, if there is a prolonged fever that cannot be explained by other reasons, and the body temperature is normal with antibiotics, but fever again after stopping the medicine, it means that they may have infective endocarditis.
3. The corresponding symptoms appear due to small vessel embolism caused by the dislodgement of bacterial emboli. Such as cerebral embolism, splenic embolism, pulmonary embolism, etc., the patient will have corresponding clinical symptoms, such as hemiplegia, aphasia, abdominal pain, blood in stool, hemoptysis, chest pain, etc.
4. Patients who have not received regular treatment for a long time may show signs of heart failure if there is damage to the heart structure. Such as coughing, breath-holding, leg swelling and other manifestations of heart failure.
If a patient has one or more of these manifestations, it is best to go to the hospital for a checkup. An experienced doctor may hear a murmur in the patient’s heart, a routine blood test will reveal an increase in white blood cells, a routine urine test will reveal microscopic hematuria or proteinuria, and then a heart ultrasound will reveal a redundant heart valve or a damaged valve, and a blood culture will produce bacteria. The diagnosis is confirmed.
Systemic damage to the heart
Infectious disease in the heart is like a skinless boil in the heart, the pus of which can travel throughout the body with the blood at any time, causing ischemic necrosis and secondary abscesses in the tissues supplied by these vessels. It is difficult to control with medications. If endocarditis occurs in a patient who has had a previous heart valve replacement, it may affect the function of the original valve and the patient may need another valve replacement.
Antibiotics before surgery
Most infective endocarditis is a bacterial infection, so antibiotic therapy is necessary; surgery is required for cases that cannot be controlled by antibiotic therapy, have complications such as heart failure, or have structural damage to the heart valves.
The key to drug treatment is to choose the right antibiotics
Early blood culture and selection of antibiotics based on culture results; intravenous route of administration; combination of drugs for early control of infection; and long-term adequate course of treatment to prevent recurrence – 4-6 weeks of antibiotic therapy. Some autochthonous valve endocarditis can be completely cured with appropriate antibiotics. Results are poorer in those with intracardiac grafts.
Surgery against diseases that are difficult to control medically
Surgical treatment is performed on the basis of infection control. Surgical procedures not only restore heart function but also prevent progressive irreversible structural damage and control the spread of infection. Early surgical treatment prevents destruction of the valve leaflets, prevents the formation of redundant organisms, dislodges emboli and protects left ventricular function, and reduces the use of antibiotics and the dysbiosis caused by prolonged antibiotic application. Over-emphasis on infection control and improvement of cardiac function may delay the timing of surgery and result in lost treatment opportunities.
Therefore, patients with infective endocarditis should have a positive attitude toward surgical treatment while emphasizing anti-infective treatment.
Special reminder: Infective endocarditis is not easily diagnosed. Because patients are given antibiotics after fever, the clinical manifestations of infective endocarditis are atypical, making diagnosis difficult for physicians. Because the disease cannot be diagnosed for a long time, patients do not receive timely treatment, resulting in delays and economic losses for patients.
Endocarditis is a serious disease that can have serious consequences if it is not treated promptly and effectively, therefore, patients are advised to visit regular hospitals and must listen to their doctors. If medication does not work, the surgery must be done.