Non-Infectious Endocarditis: Causes, Symptoms, Treatment, Surgery, Hospitals, Mortality

Non-infective Endocarditis (NIE)

1. Definition

Non-infective endocarditis (NIE) is a condition in which inflammation occurs in the inner lining of the heart, but without an infectious cause. Unlike infective endocarditis (infectious endocarditis), this condition is not caused by the invasion of external pathogens such as bacteria, viruses, or fungi. Instead, causes of inflammation in the heart's inner lining or valves include blood clots, immune responses, or other underlying diseases.

Non-infective endocarditis primarily manifests as the formation of abnormal thrombi (blood clots) on the heart valves, or as an inflammatory response arising from pre-existing heart conditions. While this condition is relatively rare compared to infective endocarditis, it can cause serious complications, making accurate diagnosis and treatment crucial.

2. Characteristics

Non-infective endocarditis is characterized by inflammation of the heart's inner lining that occurs without an infectious agentand is primarily associated with pathological phenomena related to blood clotting disorders. The main characteristics are as follows:

• Thrombus Formation: The blood clotting process occurs abnormally, resulting in thrombus formation on the endocardium. These thrombi often adhere to the valves or can block blood vessels.
• Association with Autoimmune Diseases: Non-infective endocarditis can often be associated with autoimmune diseases and is commonly observed in lupus or other immune-related disorders.
• Heart Valve Problems: Pre-existing heart conditions or valvular diseases can lead to non-infective endocarditis.
• Non-infectious: Unlike infective endocarditis, this condition is not caused by external pathogens; it primarily results from abnormal blood clotting or immune responses.

3. Causes

The primary causes of non-infective endocarditis include blood clotting problemsand autoimmune diseases. Other specific heart diseases or vascular diseases can also be causative factors. The main causes are as follows:

3.1. Blood Clotting Disorders

• Thrombi on Heart Valves: A major cause of thrombus formation on the endocardium is heart valve disease. Abnormal blood flow in the valves can cause blood to clot, forming thrombi. These thrombi can cause inflammation in the endocardium.
• Antiphospholipid Syndrome: Antiphospholipid syndrome is an autoimmune disease characterized by a tendency for abnormal blood clotting. This disease is one of the main causes of non-infective endocarditis, particularly thrombus formation on the heart valves.

3.2. Autoimmune Diseases

• Lupus: The autoimmune disease lupus can often cause non-infective endocarditis. In lupus patients, the immune system attacks its own tissues, causing inflammation of the endocardium and thrombus formation on the valves.
• Rheumatic Heart Disease: Heart disease caused by rheumatic fever can be associated with non-infective endocarditis. Rheumatic heart disease can damage the heart valves, leading to thrombus formation.

3.3. Other Causes

• Heart Disease: Pre-existing heart disease (e.g., heart valve disease, cardiac arrhythmias, etc.) can lead to thrombus formation or inflammation in the endocardium.
• Malignancies: Non-infective endocarditis can occur in some cancer patients, where tumors can form thrombi or trigger immune responses.
• Organ Transplantation and Immunosuppressant Use: In cases of organ transplantation or immunosuppressant use, abnormal immune responses can lead to non-infective endocarditis.

4. Symptoms

The symptoms of non-infective endocarditis are relatively less prominent than those of infective endocarditis, but it can still be a serious condition. The main symptoms are as follows:

• Fever: High fever can occur as non-infective endocarditis progresses. However, since there is no infection, the fever may be less persistent than in infective endocarditis.
• Fatigue and Weakness: Impaired heart function can lead to fatigue and weakness.
• Heart Murmur: Heart valve damage can cause a heart murmur, which can be detected by auscultation by a physician.
• Shortness of Breath: Impaired heart function can lead to shortness of breath.
• Other Complications: If thrombi spread to the heart or other organs, complications such as stroke, pulmonary embolism, and kidney damage can occur.

5. Treatment and Surgical Methods

Treatment for non-infective endocarditis focuses on managing the underlying conditionand thrombus treatment.

5.1. Medical Treatment

• Anticoagulants: A major treatment for non-infective endocarditis involves the use of anticoagulants (e.g., warfarin, aspirin, etc.). Anticoagulants help prevent the growth of thrombi and remove already formed thrombi.
• Immunosuppressants: In endocarditis caused by autoimmune diseases, immunosuppressants (e.g., corticosteroids, immunosuppressants, etc.) can be used. These drugs modulate the immune response to alleviate inflammation.
• Treatment of Underlying Diseases: It is important to treat the underlying diseases that cause non-infective endocarditis. For example, treating lupus or rheumatic heart disease can reduce inflammation.

5.2. Surgical Treatment

• Heart Valve Surgery: If the heart valves are severely damaged, surgery to replace or repair the valves may be necessary.
• Thrombectomy: If thrombi form on the endocardium and obstruct blood flow or impair heart function, surgery may be required to remove them.

6. Prognosis and Management Methods

The prognosis of non-infective endocarditis depends on the patient's underlying disease and response to treatment. While this condition is usually curable with appropriate treatment, the prognosis can worsen if complications occur.

6.1. Prognosis

• Treatment of Underlying Diseases: If underlying diseases (e.g., lupus, antiphospholipid syndrome, etc.) are well managed, the prognosis can be positive.
• Occurrence of Complications: If thrombi spread to other organs such as the brain or lungs, complications can occur, and in these cases, the prognosis can worsen.

6.2. Management Methods

• Regular Examinations: Regularly examine the blood clotting status to use appropriate anticoagulants and check the treatment effect.
• Immune Modulation: In endocarditis caused by autoimmune diseases, it is managed through the use of immunosuppressants or immunomodulators.
• Management of Underlying Diseases: If there are underlying diseases such as lupus or antiphospholipid syndrome, manage them thoroughly to prevent endocarditis.

Conclusion

Unlike infective endocarditis, non-infective endocarditis is a condition that occurs not due to infection by pathogens such as bacteria or viruses, but due to causes such as blood clotting and immune responses. The main causes are blood clotting disorders and autoimmune diseases, and the prognosis can be improved through proper treatment and management. Treatments include thrombus treatment, the use of immunosuppressants, and heart valve surgery, and regular management and treatment of underlying diseases are important.