What is Endocarditis?

Podcast Transcript

Announcer:

Welcome to Love Your Heart, brought to you by Cleveland Clinic's Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute. These podcasts will help you learn more about your heart, thoracic and vascular systems, ways to stay healthy and information about diseases and treatment options. Enjoy!

Haytham Elgharably, MD:

I'm Dr. Haytham Elgharably. I'm the surgical director of the Infective Endocarditis Center at Cleveland Clinic. We're going to talk today a little bit about endocarditis, which is infection of your heart tissues. Your heart has four valves and sometimes bacteria after a procedure, like dental procedures, or infection in the skin can travel through the bloodstream and attach to one of the heart valves and cause infection on that valve, which what we call medically endocarditis. That infection in the valve can destroy the valve, cause abnormal function of the valve that may need repair or replacement at some point. Sometime also the infection grows as small masses on the valve and can travel somewhere through the blood, can go to the brain, can go to your limbs, can go to your abdominal organs, causes malperfusion and problems.

The first line of treatment for endocarditis is medical therapy. So, we start antibiotics based on the culture we get from the blood, and then after that we do more imaging on the heart, such as ultrasound or echocardiography. Sometimes we do CT scans just to delineate how bad is the infection in the heart and if one of the valves need to be repaired or replaced. After a course of antibiotics, we follow the results and monitor the heart function, and if there is one of the valves that needs to be repaired or replaced, then we can evaluate you for surgery.

When you get an infection in the heart or what we call endocarditis, you may feel fever, fatigue, loss of energy. You may get short of breath if one of the valves damaged or chest pain. So, if you have persistent fevers or abnormal skin lesions, you may need to go to the hospital or the doctor to get a check.

The source of endocarditis sometimes starts again, as I said, from somehow the bacteria or the organism get access to the bloodstream. It can be happening after a dental procedure, tooth extraction, colonoscopy, abdominal procedure, sometimes infection in your joints or your skin. Then the bacteria will travel through the blood and attach to the valves of the heart, and then they grow together and destroy the valve. It's easier for the bacteria to attach if you have a prosthetic material inside the heart. So, if you have had a valve replacement before or a pacemaker leads inside the heart or aortic replacement before with a graft, that makes it easier for the bacteria to attach and cause infection too.

Surgery entails when we have to get rid of all the infection, so we have to cut the valves out. Sometimes we need to do debridement around the valve and then reconstruct the damaged area, replace the valve with either a human valve or an animal valve, and then after surgery, you will require intravenous IV antibiotics for around six weeks, which will be based on the cultures from the infected valve we took during the surgery. After six weeks, you'll see a cardiologist or infection disease doctor to stop the antibiotics and get a final check.

So, after you finish the six weeks of antibiotics and you get your follow-ups, one thing you have to be careful about to prevent this from happening again. So, it's very important if you're planning to any dental procedures, any other procedures like colonoscopy or had some infection in one of the joints or skin, you have to seek attention from your primary care physician and get prescription for antibiotics.

If you start having some similar symptoms, again, you may seek attention too. At Cleveland Clinic, our Endocarditis Center offers a multidisciplinary team expertise to evaluate endocarditis patients or patients with infection in their hearts. You get a cardiologist, a cardiac surgeon, infection disease specialist. We all look at everything together and make the best plan for the patient. These cases sometimes very complex surgeries and require certain set of expertise and skills, but this is something we here provide at the Cleveland Clinic. We're very used to treating patient with endocarditis and we have excellent outcomes.

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