Chronic Endocarditis: Causes, Symptoms, Treatment, Surgery, Mortality, Hospitals, Reasons

Chronic Endocarditis

1. Definition

Chronic endocarditis is a condition characterized by persistent inflammation of the inner lining (endocardium) of the heart or the heart valves. Compared to acute endocarditis, this condition is distinguished by itsslow and gradual progression. Chronic endocarditis is generally caused bybacterial infectionornon-infectious inflammation, with symptoms appearing gradually and progressing over a long period. This condition causes chronic damage to the heart valves and can affect heart function.

2. Characteristics

The main characteristics of chronic endocarditis arethe persistence of inflammation and its gradual progression. Unlike acute endocarditis, which presents rapidly and progresses acutely, chronic endocarditisprogresses slowlywithcontinuous inflammationaffecting the heart valves. The key characteristics are as follows:

• Slow Progression: Chronic endocarditis progresses slowly over months or years. In the early stages, symptoms may be minimal or absent, gradually developing into symptoms such as decreased heart function.
• Heart Valve Damage: Chronic endocarditis leads topersistent damageto the heart valves. Prolonged infection causesinflammatory degeneration, fibrosis, detachment, etc., impairing valve function. This results in the valves failing to function properly, potentially leading to heart failure.
• Non-Infectious Inflammation: In some cases, chronic endocarditis can be caused bynon-infectious causes (e.g., rheumatic fever, autoimmune diseases, etc.). These causes induce inflammation without infection, causing persistent damage to the heart.
• Decreased Heart Function: Persistent inflammation and damage to the valves affect the heart's hemodynamics, leading toheart failureand other forms of decreased heart function. Also, blood clots may form, or valves may detach, leading tostrokeorpulmonary embolismand other systemic complications.

3. Causes

Chronic endocarditis can be caused by various factors, and can be classified as infectious or non-infectious depending on the cause.

3.1. Infectious Causes

• Streptococcus viridans: This normal flora residing in the oral cavity and upper respiratory tract can cause endocarditis following dental procedures or oral infections. This bacteria can cause persistent inflammation of the valve, leading to chronic endocarditis.
• Staphylococcus aureus: This staphylococcus found on the skin and mucous membranes primarily affects intravenous drug users and individuals with prosthetic heart valves.
• Enterococcus: This bacterium found in the colon primarily affects people with abnormal heart valves. Infection by this bacteria can also cause chronic endocarditis.
• Other Bacteria: Various bacteria such asCorynebacterium, Pseudomonas can act as infectious agents. However, chronic endocarditis due to infectious causes is rare, often resulting from the chronic progression of an initial acute infection that has not been properly treated.

3.2. Non-Infectious Causes

• Rheumatic Fever: Rheumatic feveris an autoimmune disease that can occur after a streptococcal infection causing colds or sore throats, resulting in inflammation of the heart valves. Rheumatic fever-induced chronic endocarditis can lead tofibrosisandthickeningof the valves over time.
• Autoimmune Diseases: Lupus(SLE) andrheumatoid arthritisare autoimmune diseases that can cause chronic endocarditis. In these diseases, the immune system attacks its own tissues, causing inflammation of the endocardium.
• Metabolic Diseases: Diabetesandhyperlipidemiacan influence the development of chronic endocarditis. These diseases promote inflammatory responses and cause persistent damage to the heart valves.

4. Symptoms

Symptoms of chronic endocarditis aresubtle at the onsetcompared to acute endocarditis and worsen gradually. The main symptoms are as follows:

• Persistent Fever: Patients with chronic endocarditis may experiencelow-grade feverthat persists, sometimes worsening. Fever is caused by infection or inflammation.
• Fatigue and Weakness: Persistent inflammation and damage to the heart valves cause generalized fatigue. Patients tend to be lethargic and easily fatigued.
• Shortness of Breath: Impaired heart valve function can lead toheart failure. This can causeshortness of breathandedema.
• Heart Murmur: Inflammation of the valves produces aheart murmur, which can be detected by auscultation.
• Peripheral Vascular Changes: Patients may experienceOsler's nodes(painful small nodules), Janeway lesions(painless spots), splinter hemorrhages(hemorrhages under the fingernails) in the extremities. This is a result of blood-borne infection affecting the peripheral vasculature.
• Decreased Heart Function: Cumulative persistent inflammation and damage to the heart valves can lead toheart failure, which may be accompanied byshortness of breath, edema, andfatigue.

5. Treatment and Surgical Methods

Treatment for chronic endocarditis involves a combination ofmedicationandsurgical treatment. In cases of chronic infection, treatment is long-term and requires eliminating persistent infection.

5.1. Medication

• Antibiotic Treatment: Since most cases of chronic endocarditis are caused bybacterial infection,antibiotic treatmentis crucial. Antibiotics must be selected according to the type of bacteria and are usually administeredintravenously. Treatment can last for several weeks or months. For example, infections caused byStreptococcus viridanscan be treated withPenicillinorCeftriaxone.
• Antifungal Agents: IfCandidaor other fungi are the cause, antifungal agents are used for treatment. Fungal infections are relatively rare, but treatment may be necessary.

5.2. Surgical Treatment

• Valve Replacement Surgery: If the heart valves are severely damaged due to chronic endocarditis,valve replacement surgerymay be necessary. The surgery involves inserting aprosthetic valveor performingautologous valve repair.
• Thrombectomy: If blood clots form in chronic endocarditis and affect the heart, thrombectomy may be necessary.
• Heart Function Improvement: If heart function is severely impaired due to inflammation of the heart valves,coronary artery bypass graftingorheart transplantationmay be necessary.

6. Prognosis and Management

Chronic endocarditis requires long-term treatment and management. The prognosis depends on the cause of the infection, the condition of the heart valves, and the timing and method of treatment.

6.1. Prognosis

• Good Prognosis with Early Detection and Treatment: Chronic endocarditis can have a good prognosis withearly detectionandappropriate treatment. If valve damage is not severe, recovery is possible after treatment.
• Poor Prognosis with Delayed Treatment: If treatment is delayed or incomplete,decreased heart function, heart failure, andcomplicationscan occur. In such cases,heart transplantationmay be necessary.

6.2. Management Methods

• Regular Follow-up Examinations: Patients with chronic endocarditis should undergo regularechocardiogramsandblood teststo monitor treatment effectiveness.
• Infection Prevention: Patients may receive antibiotics before dental procedures or surgery, andhygiene managementis crucial for infection prevention.
• Maintaining a Healthy Lifestyle: Maintaining a healthy lifestyle, including diet, exercise, smoking cessation, and alcohol moderation, is essential for managing heart health.

With the management and treatment described above, chronic endocarditis can be effectively managed.