Endocarditis is an infection of the inner lining of the heart and its valves. The infection is caused by bacteria or fungi that enter the bloodstream through the mucous membranes of the mouth, open wounds, needles. It can also occur from medical procedures which involve cutting through infected skin.





Normally, bacteria which enter the bloodstream pass harmlessly through the heart and are killed by the immune system. However, bacteria circulating through the bloodstream may attach to heart tissue that is already damaged by heart disease or to an artificial heart valve. When this happens, the bacteria can hide from the immune system and cause a dangerous infection.

Endocarditis can lead to other life-threatening conditions. Stroke or reduced blood flow to other organs can occur when clumps of bacteria break off from the heart and block the blood vessels. The bacteria which cause endocarditis can also spread to other organs, causing additional tissue damage. Uncontrolled endocarditis can permanently damage the heart valves, eventually leading to heart failure.

Epidemiology
Infective endocarditis is a rare disease, with an incidence of two to six episodes per 100,000 habitants/year. Incidence is higher in elderly people; besides, this group is often affected by much comorbidity. There is a clear and observable change in the spectrum of heart diseases predisposing to infective endocarditis in the last decades. Up to one-third of the patients acquire the disease on a health-care-associated environment. Despite advances in health-care logistics, infective endocarditis remains a big concern especially in low-income countries, where the main cause of infection is rheumatic fever. In-hospital mortality persists relatively high despite development in medical and surgical treatment. Patients with infective endocarditis need rapid response and prompt diagnosis from a multidisciplinary group including cardiologists, surgeons, infectologists, and radiologists.

Types of Endocarditis
Infectious (bacterial) endocarditis: This type of endocarditis is characterized by an infection caused by bacteria or fungi that enter the bloodstream and settle in the heart lining, a heart valve or a blood vessel. This type of endocarditis is uncommon, but people with some heart conditions have a greater risk of developing it.

Non-infectious (non-bacterial) endocarditis:This type of endocarditis is characterized by various kinds of illnesses affecting the heart valves, most often the left side of the heart. The disease may be the first step in development of infectious endocarditis.

Endocarditis risk factors
Your risk is higher if you have a problem that affects blood flow through your heart. That’s because a blood flow problem makes it more likely that bacteria or fungi will attach to heart tissue. Some other things raise your risk too, because they can let bacteria or fungi enter your bloodstream.

You have a higher risk of endocarditis if you have:

Had endocarditis in the past.
An implanted heart device such as a pacemaker or implantable cardioverter-defibrillator (ICD).
A hemodialysis access or a central venous catheter.
Abnormal or damaged heart valves or an artificial heart valve.
A congenital heart defect.
Injected illegal drugs using dirty needles or without cleaning the skin.
Not all heart problems put you at higher risk for endocarditis. You do not have a higher risk if you have had:

Bypass surgery for heart disease.
Rheumatic fever without heart valve damage.
A heart attack without other complications.
Mitral valve prolapse without regurgitation or unusually thickened valve leaflets.
A coronary artery stent.
What Causes Endocarditis?
Endocarditis occurs when germs enter the bloodstream and reach the heart, multiplying and attaching to atypical heart valves or damaged heart tissue. Overgrown bacteria are the most common cause of endocarditis, although fungi and other microorganisms can sometimes be responsible for the condition. The immune system usually destroys harmful bacteria that makes it into the bloodstream, but sometimes bacteria makes it through the bloodstream and into the heart. Normal heart valves are resistant to infection, but diseased, damaged, or prosthetic heart valves are more prone to bacteria which forms endocarditis.

Bacteria and germs enter the bloodstream in several predictable ways. The following are common endocarditis causes:

Injury to the mouth, gums or skin.
Regular teeth brushing.
Flossing the teeth.
Gum disease (also known as Gingivitis).
Certain dental procedures (such as tooth extraction that involve cutting the gums).
Skin sores, abrasions or openings.
Sexually transmitted diseases (STDs).
Catheters (usually longer-term use).
Certain intestinal disorders (including inflammatory bowel disease).
Needles when getting tattoos.
Needles when getting body piercings.
Illegal intravenous (IV) drug injection (especially with used or unclean needles).
If enough bacteria enter the bloodstream, or if aggressive bacteria enter the bloodstream, endocarditis can develop even on healthy heart valves.

What is Endocarditis symptoms?
The usual signs of endocarditis are prolonged fever for several days (occasionally up to 30 days) in a child with congenital heart disease that occurs after a procedure in the mouth, intestinal tract or urinary tract. However, the infection may occur without a previous procedure.

Symptoms of endocarditis may develop slowly or come on suddenly. They include:

Fatigue
Fever
Headache
Joint inflammation or pain
Night sweats
Poor appetite and/or weight loss
Rash
More severe symptoms include:

Anemia
An enlarged spleen
Bleeding that causes small dark lines under the fingernails or small dark spots on the skin
New heart murmurs
Endocarditis complications
Complications of bacterial endocarditis include:

Heart failure
Blood clots or clumps of bacteria travel to other parts of the body (emboli). This might travel to the arteries in the heart, brain, spleen, bowel, arms, or legs.
Infection in other parts of the heart
Weakened blood vessel (aneurysm), such as in the brain
Kidney injury or disease
Death

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Cardiovascular system diseases refer to conditions that affect the heart and blood vessels, including coronary artery disease, congestive heart failure, arrhythmias, and stroke.

By identifying and managing these risk factors, individuals can reduce their chances of developing various Types Of Cardiovascular Diseases or experiencing severe complications if they already have the condition.