Endocarditis

What Are the Parts of the Heart?

The heart is the organ that pumps blood through your body, bringing oxygen and nutrients to your muscles, internal organs, and bones. The heart itself is made up of different parts, including:

• Chambers. The heart has four chambers. Two upper chambers, the atria [AY-tree-UH], are responsible for taking blood in from other parts of the body and refilling it with oxygen. Two lower chambers, the ventricles [VEN-trik-UHLS], hold fresh blood that is ready to go through the circulatory system.
• Valves. Heart valves control blood flow between the chambers of the heart.
• Heart wall. The heart is surrounded by several layers of tissue that keep the different parts of the heart together and protect it from harm. The layers that make up the heart’s wall are:
  • Epicardium [eh-PEE-kar-DEE-uhm]. The tissue on the outside of the heart wall.
  • Myocardium [MY-oh-KAR-dee-UHM]. The tissue in the middle of the heart wall.
  • Endocardium [EN-doh-KAR-dee-UHM]. The tissue on the inside of the heart wall, lining the chambers.

Endocarditis [EN-doh-KAR-dye-TIS] is an infection of the endocardium, the inner layer of the heart wall. It can also infect the lining of the valves in the heart. There are a few different kinds of germs that can cause this illness:

• Bacteria. Bacterial endocarditis is the most common form of this illness, and is caused by microscopic bacteria getting into the lining of the heart.
• Fungi. Spores from fungi can colonize (grow) in the endocardium, causing this illness. Fungal infections are less common than bacterial infections.

Symptoms for endocarditis can be different depending on how long the heart has been infected, other conditions your child might have, and differences between individual people. If your child has endocarditis, they might have these symptoms:

• Fever, chills, and sweating. These symptoms often show up first, and can come and go. You or your child might notice them more at night.
• Tiredness.
• Weakness
• Joint pain.
• Muscle pain.
• A hard time breathing.
• Weight loss.
• Neurological problems like seizures.

Other, less common symptoms of endocarditis can include:

• Splinter hemorrhages [HEH-mor-ij]. These are small bleeding areas under your child’s nails.
• Janeway lesions. Red skin spots on the palms of your child’s hands and/or the soles of their feet.
• Osler nodes. Red, painful bumps on the pads of your child’s fingers or toes.
• Shortness of breath.
• Swelling of the feet, legs, or belly.

Endocarditis is a serious problem that can harm or even kill your child, so you should see a doctor if you think your child might have this infection. You should take your child to the emergency room right away if they are showing signs of a more serious or advanced endocardial infection.

There are other conditions that can put your child at greater risk for endocarditis. You should tell your doctor if your child has had heart valve surgery, an artificial heart valve, a heart transplant, a heart valve problem, or a heart defect.

While not as much of a risk for children, people who inject drugs (like heroin) are also at risk for endocarditis because injecting drugs gives bacteria a chance to get into the bloodstream.

The symptoms of endocarditis are caused by a bacterial or fungal infection in the endocardium, the inner part of the wall around your child’s heart. When bacteria or fungi grow in this area, they can hurt the tissue and cells in the wall, causing serious heart problems.

Bacteria and fungi can get into the heart wall in a few different ways. The most common causes include:

• Central line. A central line is a catheter [KATH-ih-tur] (a long, thin tube) that goes to your child’s heart through one of their veins. Catheters can be used to put medicine into your child’s body or to take blood samples for testing. Since the catheter is exposed to the outside world, it’s possible for bacteria to get into your child’s heart through this tube.
• Dental surgery. Dental surgery, like wisdom tooth removal, can make an opening for bacteria in the mouth to get into the bloodstream, where they can infect the heart and other parts of your child’s body.
• Other surgery. Surgeries on your child’s internal organs, like the lungs, urinary tract, bones, or muscles, can give bacteria a chance to get into your child’s bloodstream and lead to endocarditis.

If your doctor thinks your child might have endocarditis, they will do several tests to look for signs of the disease and rule out other causes of your child’s symptoms. These tests can include:

• Transthoracic [trans-thor-AS-ik] echocardiography [EH-koh-KAR-dee-AH-gruh-FEE], or TTE. This test uses ultrasound to create pictures or videos of the heart. A technician places a small device on your child’s chest or belly to take the pictures.
• Blood culture. In this test, your doctor takes a small sample of your child’s blood and sends it to a lab. A lab technician will put the blood on a special dish and look for any bacteria or fungi that grow there.
• Complete blood count, or CBC. This test takes a sample of your child’s blood and measures the amount of red blood cells, white blood cells, and hemoglobin. This information can be used to diagnose endocarditis and other problems with the heart and blood.

If your child is diagnosed with endocarditis, your doctor might recommend a few different treatments depending on how serious the infection is, how old your child is, and how the infection was caused.

The most common treatment is long-term antibiotics. It can take a long time to get rid of all the bacteria in the endocardium, so your doctor might have your child take antibiotics for 4 to 8 weeks. Antibiotic treatment will probably start in the hospital, and can be continued at home once your child starts feeling better.

Your child might need surgery to replace an infected heart valve if:

• Antibiotics don’t get rid of endocarditis.
• The infection causes life-threatening symptoms like strokes or heart failure.
• The infection has permanently damaged the heart valves.

Not all cases of endocarditis can be prevented, but there are some factors that can put your child at higher risk for getting this infection, such as:

• Certain birth defects in the heart.
• Heart transplants.
• Problems with the heart valves.
• Prosthetic heart valves.
• A history of endocarditis.

If any of these apply to your child, your doctor might have your child start preventive antibiotics during certain procedures that can cause endocarditis, like dental procedures, surgery, and treatments for some skin infections.

Endocarditis [EN-doh-KAR-dye-TIS] is a serious bacterial or fungal infection in the inner wall of the heart, called the endocardium, that surrounds the heart valves and chambers.