Endokardiitin

Endokardiitin is an inflammation or infection of the endocardium, the lining inside the heart, most often involving the heart valves or implanted cardiac devices. It is usually caused by infection, most commonly by bacteria, but fungi can also be responsible. The condition can present acutely with rapid illness or develop more gradually, and it requires prompt evaluation and treatment.

Risk factors include intravenous drug use, prosthetic heart valves or intracardiac devices, prior endokardiitin, congenital heart disease, and conditions that cause damaged endocardium. Hospitalization and catheter use can also contribute to acquiring the infection, and culture-negative endokardiitin can occur when prior antibiotics have reduced detectable organisms.

Pathophysiology typically begins with bacteremia or fungemia that allows microorganisms to adhere to abnormal endocardial surfaces, leading to the formation of vegetations composed of microorganisms, fibrin, and platelets. These vegetations can damage valvular tissue, cause heart failure, and fragment to form emboli that lodge in distant organs such as the brain, kidneys, or spleen.

Clinical presentation usually includes fever and a new or changing heart murmur. Other signs can include signs of embolic events (stroke or limb ischemia) and immune phenomena such as Osler nodes, Janeway lesions, or Roth spots. Diagnosis relies on clinical criteria (Modified Duke criteria), serial blood cultures, and echocardiography to demonstrate endocardial involvement. Cultures may be negative in some cases.

Treatment focuses on prolonged intravenous antibiotics tailored to the identified organism, typically 4–6 weeks, with organ-specific adjustments for native versus prosthetic valve infection. Surgery may be required for heart failure due to valve dysfunction, uncontrolled infection, or large vegetations. Prevention guidelines advise antibiotic prophylaxis for selected high-risk patients undergoing dental or certain invasive procedures, according to local recommendations. Prognosis depends on the agent, host factors, and timeliness of treatment, but early diagnosis and therapy improve outcomes.