Symptoms of endocarditis

introduction

Endocarditis is an inflammatory process affecting the endocardium, the inner layer that lines the heart. It can be caused by immune reactions caused by bacteria or viruses, for example, as well as by a deposit of immune complexes or antibody reactions.

The inflammation can be classified according to location and appearance. Mostly the heart valves are affected, in rare cases it is the heart chambers and blood vessels. With a bacterial infection, a mostly greenish change in the valves is visible.

Endocarditis starts with one Change in blood flow and compositionwhich enables colonization of the endocardium on a previously damaged surface. The consequence of these inflammatory processes can be Spread of inflammation to muscles, heart valves and all of them Inner skin of the heart be.

Depending on the severity of the endocarditis, it can lead to Heart failure and unspecific signs of infection come. The heart failure can hereby by a Failure of the heart valves or by a Reduced blood flowwhich can lead to the death of heart muscle cells. In the case of heart failure, the heart is no longer able to pump the amount of blood produced into the body's circulation in a certain time.

Symptoms

Signs of increasing heart failure are heart murmurs and an increased heart rate. Heart murmurs are sounds detected when listening with a stethoscope that do not correspond to the normal heart sounds that are produced by opening or closing the heart valves. Heart murmurs are caused by damage to the heart valves, which means that they no longer open or close properly. This creates turbulence in the blood that the attending physician can perceive with his stethoscope.

For more information on abnormal heart murmurs, please also read our page Heart murmurs.

The increased heart rate can more easily lead to cardiac arrhythmias.

Common signs of inflammation in endocarditis include fever and chills. Fever is an increase in body temperature that deviates from the setpoint given by the brain. As a result, the body tries to fight the inflammation by improving its immune response to the infection and killing the pathogens. The chills are tremors in the muscles that make the body temperature rise.

After activating the immune system and fighting the pathogen, the fever drops again. The body temperature is now lowered by increased sweating. Another symptom is night sweats. Night sweats are those that deviate from normal sweat production at night, which can vary in intensity depending on the cause. In the worst case, the patient has to get up several times during the night to wash his soaked bed linen. Acute or chronic infectious diseases, tumors, hormonal disorders of the metabolism, mental illnesses, neurological diseases, nutrition, medication and autoimmune diseases can be reasons for increased night sweats. It is particularly important to recognize the composition of fever, night sweats and weight loss. They are called B symptoms and can indicate a tumor.

Night sweats can also cause a feeling of coldness, which is another symptom of endocarditis. The sensation of cold arises because the body regulates its temperature through sweating and can thus lower it. So it is mostly a result of sweating.

Weight loss can also be a symptom of endocarditis. This is then unintentional and occurs without the patient changing his eating habits or through a decreased appetite in the patient. Weight loss can generally be classified according to intentional or unintentional, duration, amount of body weight lost and loss of appetite. In addition to infectious diseases, which also include endocarditis caused by the penetration of external pathogens into the bloodstream, are:

• Intestinal infections and chronic bowel diseases such as Crohn's disease
• Inflammation of the gastric mucosa
• Inflammation of the pancreas
• Ulcers
• Worm infestation
• Food intolerance such as gluten or lactose intolerance
• Diseases of the liver, kidneys and bile ducts
• Metabolic disorders such as a thyroid dysfunction
• Type 1 diabetes
• Cancers
• mental illness such as depression
• Eating disorders such as anorexia or bulimia
• and taking medication and drugs

other causes of unwanted weight loss.

Loss of appetite is caused by a disturbance in the brain system that is responsible for hunger, satiety and the desire to eat. This system is controlled by hormones and other messenger substances. It must be differentiated from the purely physical need for food in the event of an undersupply, which the body signals, among other things, by a growling stomach.

The inflammatory reaction caused by endocarditis can lead to a Infectious Anemia come, this is an anemia caused by this infection. Infectious anemia can also be caused by autoimmune diseases or tumors. Anemia is associated with an iron deficiency and can be determined by the fact that when a blood smear is viewed microscopically, the red blood cells have a reduced red color and a reduced volume.

In addition, the inflammation parameters CRP and the rate of sedimentation are increased (see blood test).

During or after endocarditis, pain in the joints and joint inflammation can occur. As a result, the joint usually swells and is restricted in movement. This accompanying symptom particularly often affects the hip, knee or ankle joints.

Fatigue, exhaustion and poor performance are also signs of infection in endocarditis.

The most dangerous complications are blood clots deposited under the heart valves or accumulated inflammatory cells that are loosened and detached by the bloodstream and enter the vasculature via the ventricles. From there they can get stuck in all of the following vessels and block them. One speaks here of an embolus that triggers a vascular embolism. The organ area supplied by the vessel is no longer adequately supplied with blood and the lack of nutrients and oxygen can lead to the death of cells. This can occur in all organs, the lungs and brain are particularly at risk.

The kidney can also be affected by an embolism or lead to increased excretion of blood and proteins in the urine through foci of inflammation in the kidney tissue.

In the worst case of endocarditis, the inflammation spreads from the inner lining of the heart, so that the pathogens can be carried to the brain. One then speaks of one Herd encephalitisthat can cause clouding of consciousness. Infarcts of the retina of the eye and paralysis of facial areas are also possible due to cranial nerve failure.

Depending on the trigger and symptoms of the endocarditis, the attending physician must decide whether therapy with immunosuppressants, antibiotics or antimycotics makes sense. Antifungal drugs are effective against fungi. Endocarditis could also be triggered by bacteremia.

Other accompanying symptoms

General feeling of weakness

A general feeling of weakness is a rather unspecific symptom and yet an expression of the fact that the body uses its energy to deal with the pathogens that have entered. The body's energy expenditure is increased during this time, for example because the heart rate is increased and the body produces more cells that serve to defend itself against pathogens.

Loss of appetite

The loss of appetite is a result of hormonal dysregulation of the body in the brain. Here hormones and other messenger substances regulate our feeling of hunger and satiety, which deviate from the norm in the event of illness. In the acute state of illness, the body is "more important" to correcting the illness, so that it tolerates the dysregulation and only tries to regain a normal feeling of hunger when the acute illness phase has been overcome.

Read more on the subject here Loss of appetite.

Weight loss

Weight loss is also a relatively unspecific symptom of endocarditis and basically goes with any inflammation, as the body uses more energy in this situation than is made available to it. Often the food intake is restricted as part of an illness and the fluid intake is usually reduced. Due to the increased body temperature, people burn more energy in this situation because our metabolism runs faster, the heart pumps more and breathes more. In addition, increased sweating leads to water loss, which is also reflected in weight loss.

Read more on the subject here Unintended weight loss.

Muscle and joint pain

Muscle and joint pain are not bad per se, but rather a sign that the body is in the process of killing off the invading pathogens. The immune system uses messenger substances to recognize and localize pathogens, the side effect of which, however, is that they make people more sensitive to pain. The pain threshold is thus lowered.
In addition, a small amount of toxins and breakdown products are stored in the joints, which cannot be removed here immediately, but are only gradually excreted, so that they can cause pain during the illness.

Punctiform skin bleeding (petechiae)

The so-called petechiae are bleeding into the skin the size of a pinhead. Usually several of these points are arranged in small groups. They arise as a result of a blood clotting disorder in which the number of blood platelets, the so-called thrombocytes, is noticeably reduced. The natural balance between blood coagulation and bleeding tendency is disturbed as a result of the platelet deficiency and small superficial hemorrhages in the skin can occur.
A blood clotting disorder is an expression of the body's strong inflammatory reaction, which uses up platelets and does not keep up with the production of new blood platelets as quickly.

Read more on the subject here Petechiae.

Osler nodules

Osler nodules are about four to six millimeters in size, reddish nodules that show up on the fingers and toes. They are painful and a typical accompanying symptom of bacterially caused endocarditis. They are probably caused by a deposit of the body's own antibodies in the small blood vessels of the hands and feet, which in turn cause inflammation.

Bleeding in the eye

As with bleeding from the skin, bleeding in the eye can also be explained by a reduced number of platelets. Blood clotting is greatly delayed and the blood vessels are not properly sealed.
In addition, there is an inflammatory reaction in the blood vessels of the eye, similar to the Osler nodules.
However, the small hemorrhages in the eye can only be made visible with certain devices and are a relatively specific sign of the presence of endocarditis. In medical use they are called "Roth spots" designated.