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Endocarditis


Overview :

The endocardium lines all four chambers of the heart—two at the top (the right and left atria) and two at the bottom (the right and left ventricles)—through which blood passes as the heart beats. It also covers the four valves (the tricuspid valve, the pulmonary valve, the mitral valve, and the aortic valve), which normally open and close to allow the blood to flow in only one direction through the heart during each contraction.

For the heart to pump blood efficiently, the four chambers must contract and relax, and the four valves must open and close, in a well coordinated fashion. By damaging the valves or the walls of the heart chambers, endocarditis can interfere with the ability of the heart to do its job.

Endocarditis rarely occurs in people with healthy, normal hearts. Rather, it most commonly occurs when there is damage to the endocardium. The endocardium may be affected by a congenital heart defect, such as mitral valve prolapse, in which blood leaks through a poorly functioning mitral valve back into the heart. It may also be damaged by a prior scarring of the heart muscle, such as rheumatic fever, or replacement of a heart valve. Any of these conditions can damage the endocardium and make it more susceptible to infection.

Bacteria can get into the blood stream (a condition known as bacteremia) in a number of different ways: It may spread from a localized infection such as a urinary tract infection, pneumonia, or skin infection or get into the blood stream as a result of certain medical conditions, such as severe periodontal disease, colon cancer, or inflammatory bowel disease. It can enter the blood stream during minor procedures, such as periodontal surgery, tooth extractions, teeth cleaning, tonsil removal, prostate removal, or endoscopic examination. It can also be introduced through in-dwelling catheters, which are used for intravenous medications, intravenous feeding, or dialysis. In people who use intravenous drugs, the bacteria can enter the blood stream through unsterilized, contaminated needles and syringes. (People who are prone to endocarditis generally need to take prescribed antibiotics before certain surgical or dental procedures to help prevent this infection.)

If not discovered and treated, infective endocarditis can permanently damage the heart muscle, especially the valves. For the heart to work properly, all four valves must be functioning well, opening at the right time to let blood flow in the right direction and closing at the right time to keep the blood from flowing in the wrong direction. If the valve is damaged, this may allow blood to flow backward—a condition known as regurgitation. As a result of a poorly functioning valve, the heart muscle has to work harder to pump blood and may become weakened, leading to heart failure. Heart failure is a chronic condition in which the heart is unable to pump blood well enough to supply blood adequately to the body.

Another danger associated with endocarditis is that the vegetation formed by bacteria colonizing on heart valves may break off, forming emboli. These emboli may travel through the circulation and become lodged in blood vessels. By blocking the flow of blood, emboli can starve various tissues of nutrients and oxygen, damaging them. For instance, an embolus lodged in the blood vessels of the lungs may cause pneumonia-like symptoms. An embolus may also affect the brain, damaging nerve tissue, or the kidneys, causing kidney disease. Emboli may also weaken the tiny blood vessels called capillaries, causing hemorrhages (leaking blood vessels) throughout the body.




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