Infective Endocarditis

Patient Education

What is Infective Endocarditis?

Infective Endocarditis is a rare condition involving inflammation of the inner lining of the heart and may involve the valves of the heart. It is caused by micro-organisms which colonize and infect the heart valves. It can lead to rapid deterioration of the body if not diagnosed and treated effectively.

What is the cause of Infective Endocarditis?

Infective Endocarditis is usually caused by virulent organisms. Around 0-90% cases are caused by bacteria, namely Gram positive streptococcus, Staphylococcus and Enterococcus.

Other causative organisms include HACEK group: Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella.

1% of cases are caused by fungi namely, Candida and Aspergillus.

What are the predisposing factors of Infective Endocarditis?

In children, a history of congenital heart disease is the most common risk factor of developing Infective Endocarditis.

Overall, recent vascular catheterization, hemodialysis or extra-cardiac operations are the common predisposing factors for developing Infective Endocarditis.

Other factors are immunocompromised patients, intravenous drug users, poor dentition, degenerative heart disease and rheumatic heart disease.

What are the symptoms of Infective Endocarditis?

Infective Endocarditis initially presents as fever, chills, malaise and fatigue. Symptoms involving the cardio-pulmonary system like chest pain, difficulty breathing, decreased exercise tolerance occur less commonly.

Diagnosis is made by the Duke-0ISCVID IE criteria 2023.

Major Criteria include: Positive blood cultures, Positive laboratory tests, ECHO findings, PET/CT imaging, Surgical evidence of Infective endocarditis during direct inspection.

Minor Criteria include: Previous history of Infective endocarditis, Fver, Vascular phenomenon, Immunological phenomenon, Microbiological phenomenon, Imaging and Physical examination.

Diagnosis is made by 2 major, 1 major and 3 minor or 5 minor criteria.

What are the treatment options available?

After initially stabilizing the patient, specific antibiotic medications are started. Antibiotic treatment depends on the organism causing the infection and its resistance to certain medications. The nature of the valve involved is also considered. Surgical intervention is also required in severe cases to limit the complications.

Acute valvular incompetence leading upto heart failure is the most common complication and occurs in one- third of patients. Neurological complications account for 15-30% of all cases. This includes Ischemic stroke, Intracranial bleed, Meningitis, Intracranial abscess and Intracranial aneuryms.

Less common complications include Intracardiac abscess, atrio-ventricular blocks, renal failure, splenic infarcts and abscess.

Arterial emboli are feared complications as they can travel to the gut and cause Acute mesenteric ischemia or bowel necrosis.