The inflammation destroys the heart valves/prosthetic heart valves and severe leakage of the valves can develop within a short time. Another complication of endocarditisThis is an inflammation of the inner skin of the heart (endocardium), which lines the heart cavities and forms the structure of the heart valves. Mostly bacteria are the cause, more rarely fungi. Endocarditis caused by viruses is not known. Symptoms: Fever over a longer period of time, cardiac rhythm disorders and cardiac insufficiency. People with congenital heart defects are particularly at risk (see endocarditis prophylaxis). Endocarditis can lead to acquired heart defects, especially valve defects in adulthood. is the embolismSmall particles washed away with the bloodstream (= embolus, usually parts of blood clots from another part of the circulatory system) can cause blood vessels to close. As a result, the cells supplied by the blood vessel in question die. Air, fat and foreign bodies that get into the vessels can also cause an embolism. of endocarditic tissue deposits or blood clots, which can lead to strokes, pulmonaryBelonging to the lungs. embolisms or kidney damage. Infective endocarditis is almost always accompanied by fever and is often fatal if left untreated. Other causes of endocarditis besides infection with bacteria are tumours and autoimmune diseases, whereby patients with a pre-existing heart valve defectLeakage (insufficiency) or narrowing (stenosis) of a heart valve. have an increased risk of developing endocarditis.

Typical symptoms of endocarditis include fever of varying levels, night sweats, weakness, and weight loss. In addition, peripheralBeing far at the edge, not at the centre of the body, far from the heart, e.g. hands and feet, fingers, etc. embolisms can cause small haemorrhages, for example in the area of the hands and feet. More serious symptoms are impaired consciousness, acute heart failure, and high-grade cardiac arrhythmias. The diagnosis of infective endocarditis is difficult because of the wide range of clinical presentations. In addition to determining the inflammation levels in the laboratory and taking blood cultures to identify a potential pathogen, the assessment of the heart valves and heart chambers by trans-thoracic or transoesophageal echocardiography plays a crucial role. If septic emboli are suspected, cross-sectional imaging by computed tomography should also be performed.

With pathogen-specific antibiotic therapy, endocarditis can be treated with medicationAdministration and dosage of a medicine., but mortality is still very high. In the case of pronounced infections and especially in patients who have undergone previous surgery, in addition to antibiotic therapy, cardiac surgery with a heart-lung machineEquipment that takes over the work of the lungs and the stopped heart during heart surgery. The blood is directed from the vena cavae and thus out of the body into the machine, where it is enriched with oxygen and then pumped back into the body. During this process, the blood is cooled down and warmed up again after the operation. is therefore always necessary for complete control of the infection. Indications for surgery depend on the type and virulence of the pathogen, the extent and type of valveValve. damage (perforationProcess at the end of which a breakthrough has taken place. If deliberate, the artificial creation of a breakthrough., fistula formation, paravalvular spread, abscess), the associated haemodynamic impairment, the clinical symptoms (heart failure, persistentContinuous, perpetual. fever, sepsisAlso colloquially called blood poisoning, it is a generalised infection and inflammatory reaction of the body affecting the whole body. The pathogens, mainly bacteria, can be detected from the blood.), the detection and size of vegetations, whether peripheral/central embolisation has taken place, the patient’s age and any concomitant diseases.

The primary goal of surgical treatment is the complete removal of the infected tissue or foreign material. In addition, valve function should be restored and intracardiac defects corrected. Rarely, the treatment of additional extracardiac complications is also necessary. These include embolectomies for occlusion of the extremity arteries, drainageDrainage of excess fluids (e.g. wound and lymph fluid). of metastatic abscesses, splenectomy for splenic abscess or resectionSurgical removal or surgical reduction. of a mycotic aneurysmAbnormal dilatation of a blood vessel or a chamber of the heart.. The indication and timing of surgery must be decided individually according to the individual case, bearing in mind it is only possible to control the infection and avoid organ complications with early surgical interventionA quick medical measure to slow down the progression of a disease, e.g. with the help of the cardiac catheter (interventional cardiac catheter technique) an acutely occluded coronary vessel is reopened and thus the spread of the heart attack area is stopped..

Endocarditis prophylaxis

During dental, diagnostic (e.g. endoscopies) and surgical procedures, bacteria can potentially be washed into the bloodstream. In the case of already defective heart valves or defects in the inner lining of the heart (endocardiumInner lining of the heart; one of three membranes of the heart. The endocardium is a thin layer of cells (–> endothelium) that covers all the inner walls of the heart chambers, the large vessels of the heart and the surface of the heart valves.), the bacteria can accumulate and thus lead to the destruction of the tissue. Therefore, patients with congenitalCongenital. or acquired heart defects, as well as after heart valveIn the inflow and outflow area of the heart chambers there are valves which prevent the blood from flowing back in the wrong direction. Each heart half has a sail valve and a pocket valve: 1. Tricuspid valve (between the right atrium and right ventricle) 2. Pulmonary valve (between the right ventricle and pulmonary artery) 3. Mitral valve (between the left atrium and left ventricle) 4. Aortic valve (between the left ventricle and the aorta). surgery, should be given endocarditis prophylaxisMeasures taken for prevention. As a rule, precautions are taken to ward off a possible impending illness. (e.g. endocarditis prophylaxis). with medication during the above-mentioned procedures.