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Each inflammatory process within the heart is a serious disease, because if left untreated, it leads to serious complications and, consequently, to death. The importance of the heart as an organ of our body is unquestionable, therefore it is very important to quickly recognize the infection in it and implement the appropriate treatment.
Taking into account the anatomy of the heart, there are three main groups of inflammations:
- Endocarditis
- Myocarditis
- Pericarditis
In severe cases, it is possible to simultaneously engage the inflammatory process in all structures of the heart.
Infective endocarditis is a disease in which the inflammatory process affects the endocardium (the internal structure of the heart) in the valves, atria and ventricles, less frequently the large blood vessels in the chest and foreign bodies in the heart, e.g. artificial valves, pacemakers. The most common valve infection is the mitral and aortic valve.
On the basis of epidemiological data, about 3000 cases are diagnosed in Poland each year and the risk of the disease increases with age.
People who are at greater risk of developing endocarditis include:
- people with heart defects, in particular those with congenital cyanotic defects
- people with acquired heart defects, in particular as a result of a history of rheumatic fever
- people after surgical correction of valve defects – the presence of artificial valve prostheses
- people who have had previous endocarditis
- drug addicts addicted to intravenous drugs
The main culprits of endocarditis are bacteria, with streptococci and staphylococci the most common of these. Less commonly, the infection can be caused by gram-negative rods and fungi.
In the case of endocarditis in drug addicts, the infections are mixed, i.e. the process is caused by several different bacteria, often not very characteristic. In about 20% of cases of endocarditis, the etiological factor cannot be determined.
Most often, endocarditis is preceded by a generalized infection of the organism, which occurs during minor diagnostic or dental procedures, and the source of bacteria may be the digestive tract, respiratory tract or skin.
Clinical symptoms that may suggest endocarditis include:
- high fever or low-grade fever
- general weakness, joint and muscle pain, loss of appetite, weight loss
- the doctor finds a heart murmur
- symptoms related to congestion, e.g. limb paresis, speech disorder, blurred vision, back pain or abdominal pain
- the presence of hemorrhagic spots on the palms and soles
- painful, reddish calluses on the fingers and toes – the so-called Mosler’s nodules
Due to the fact that the symptoms are not specific, it is important to confirm the diagnosis based on diagnostic tests. The basic examination to diagnose endocarditis is cardiac echocardiography (ECHO) and multiple blood cultures to determine the etiological factor.
Infective endocarditis is an indication for inpatient treatment.
Treatment is based on the use of long-term antibiotic therapy administered intravenously for about 4-6 weeks. Approximately 30% of patients also require surgery, such as replacement of an infected artificial valve.
The consequences of infective endocarditis may be heart failure, damage to the valves and the effects of embolism in the CNS or other organs.
The prognosis of untreated patients is poor. Patients most often die from decompensated heart failure or embolism.
It is very important to prevent endocarditis in people from risk groups, which consists in using an antibiotic cover before dental, diagnostic or therapeutic procedures. The antibiotic cover is reduced to taking an oral antibiotic (amoxicillin or clindamycin) one hour before the planned procedure.
Procedures with a high risk of infective endocarditis include, among others tooth extraction, tartar removal, root canal treatment, tooth implantation, tonsillectomy, bronchoscopy, cystoscopy, prostate biopsy, endoscopic biliary tract surgery.
Myocarditis is an infectious disease that affects the heart muscle cells (cardiomyocytes). Autoimmune processes that are the result of infection and lead to permanent damage to the heart muscle play an important role in the pathogenesis.
Myocarditis is more common in young people.
The disease can be the result of infection with various microorganisms, but the most common etiological factors are viruses. Among them, myocarditis is very often caused by group B Coxsackie viruses, influenza virus and adenoviruses.
The main problem of myocarditis in the initial period is the lack of characteristic clinical symptoms. Vigilance should arouse symptoms such as:
- exercise dyspnea
- general weakness, limitation of exercise tolerance
- pain in the chest
- feeling of pounding or uneven heartbeat
especially when these symptoms appear after a respiratory tract infection or influenza.
The disease may be electrifying, acute, subacute or chronic.
Unfortunately, there is no good diagnosis that would allow a quick and accurate diagnosis. The following are helpful in diagnosis: blood tests (morphology, biochemistry), ECG, ECHO of the heart, magnetic resonance imaging, possibly a cardiac biopsy and diagnosis based on histopathological examination.
Treatment of myocarditis is symptomatic, i.e. limiting physical activity, avoiding the use of non-steroidal anti-inflammatory drugs, and combating cardiac arrhythmias. Unfortunately, there is no causal treatment – we do not have effective antiviral drugs. In severe heart failure, the only salvation is a heart transplant.
The prognosis in most cases of acute and fulminant myocarditis is favorable – patients recover. However, the prognosis in subacute and chronic forms is poor. These patients most often die from severe, progressive heart failure.
Pericarditis is a disease in which the inflammatory process affects the pericardial sac with a characteristic accumulation of fluid in the pericardial cavity. Depending on the duration of the disease, there are: acute, subacute and chronic pericarditis.
The disease occurs at any age, but is more common in young adults. Very often, pericarditis is preceded by an infection of the upper respiratory tract. Among the infectious factors of endocarditis, viruses (enteroviruses, influenza viruses, adenoviruses, HIV virus), bacteria (pneumococci, staphylococci, tuberculosis) and fungi play an important role.
Symptoms of endocarditis:
- fever
- pain in the area of the breastbone or on the left side of the chest, stabbing, increasing in the supine position and coughing, and decreasing in the sitting position
- dry cough, shortness of breath
- characteristic auscultation changes, the so-called pericardial friction
The diagnosis is based on the clinical picture and the result of echocardiography.
Treatment of endocarditis includes causal treatment: antibiotic therapy, the use of anti-tuberculosis or antifungal drugs, and the use of non-steroidal anti-inflammatory drugs or colchicine.
Pericarditis is self-limiting in uncomplicated cases, and the main complications include constrictive pericarditis and cardiac tamponade, requiring urgent cardiac surgery.
Text: Mirosław Jawień, MD, PhD