Rheumatic Endocarditis (Post-infectious Endocarditis)

Rheumatic Endocarditis (Post-infectious Endocarditis)

Rheumatoid endocarditis (postinfectious endocarditis) is inflammation of the lining of the heart caused by the body’s autoimmune response to certain streptococci. Most often, children and adolescents are affected by rheumatic endocarditis, which is rare in industrialized countries today.

What is rheumatic endocarditis?

Rheumatic endocarditis is an inflammatory change in the inner lining of the heart (endocardium), which is caused by an immunological dysregulation of the organism (autoimmune reaction) after an infection with group A beta-hemolytic streptococci and belongs to the symptomatic spectrum of rheumatic fever. For about intervertebral disc degeneration, please visit bittranslators.com.

In most cases, the mitral and aortic valves, especially the valve edges that are subject to greater mechanical stress, are affected by rheumatic endocarditis. Damage to the heart valves is a corresponding long-term consequence of rheumatic endocarditis. It is primarily adolescents and children, especially between the ages of 5 and 17, who develop rheumatic endocarditis after tonsillitis or pharyngitis caused by streptococci.

Causes

Rheumatic endocarditis (post-infectious endocarditis) is due to a dysregulation of the body’s defense system as a result of an infection with group A beta-hemolytic streptococci.

Group A beta-hemolytic streptococci primarily cause inflammatory diseases of the pharynx such as tonsillitis (tonsillitis), pharyngitis (pharyngitis), scarlatina (scarlet fever) or otitis media (middle ear infection) and in some cases skin infections such as erysipelas (erysipelas) or pyoderma (purulent infection of the skin layers).) out.

The rheumatic endocarditis is not due to colonization by streptococci, but to an autoimmune reaction of the organism. This forms so-called antibodies against specific protein components of the bacteria, which, among other things, resemble the proteins on the surface of the endocardial cells.

Since the antibodies wrongly also react to endocardial structures (especially the heart valve), inflammatory changes occur, a rheumatic endocarditis, through which the heart valves can thicken, roughen and stiffen and finally their ability to function can be restricted.

Symptoms, Ailments & Signs

Rheumatic endocarditis is a symptom of rheumatic fever that can develop as a result of streptococcal infection. It usually takes two to three weeks before the first signs of inflammation of the inner lining of the heart appear. Rapid heartbeat (tachycardia) and cardiac arrhythmia occur.

The misdirected antibodies attach themselves to the heart and trigger various reactions in the connective tissue, causing the heart valves to thicken and the inner skin to become rough. This changes the heart sounds. Pain in the heart region and protruding neck veins are also possible. Since the heart can no longer pump sufficiently through the inflamed inner skin, shortness of breath and reduced performance can occur.

The valve leaflets often stick together due to the inflammation and contract. As a result, they no longer close properly and lose their effectiveness as a valve; or they no longer open wide enough, which reduces the flow of blood from one chamber to the other. Since rheumatic endocarditis occurs as part of rheumatic fever, all the symptoms of this disease are also present.

The typical symptoms are fever and a general feeling of illness. The joints are inflamed and painful, and the overlying skin is red and swollen. It usually starts with one joint and jumps to others. In addition, there are so-called rheumatic nodules and red-spotted skin changes.

Diagnosis & History

An initial suspicion of rheumatic endocarditis (postinfectious endocarditis) is based on a previous infection with group A beta-hemolytic streptococci and characteristic symptoms such as abnormal heart murmurs, high fever, tachycardia (increased heart rate), general malaise and polyarthritis (joint pain) with pronounced tenderness and shortness of breath.

The diagnosis of rheumatic endocarditis is confirmed by an echocardiogram (ultrasound of the heart) and an ECG, which can be used to determine heart valve changes, an existing heart failure or cardiac arrhythmias. A blood analysis can detect the antibodies formed in the blood. An increased CPR value, an increased concentration of white blood cells in the blood and an accelerated erythrocyte sedimentation rate (ESR) also indicate rheumatic endocarditis.

After the start of therapy, rheumatic endocarditis usually subsides after 6 weeks (75 percent) or 3 months (90 percent), although the course can be prolonged in the case of pronounced heart valve involvement. Untreated rheumatic endocarditis has a 50% chance of developing rheumatic endocarditis again, which is also the most common cause of mitral valve stenosis.

Complications

Rheumatic endocarditis can lead to malfunctioning of the heart valves. This increases the risk of serious cardiovascular problems and heart attacks. The scarring changes in the heart valves permanently reduce the heart function and thus promote heart failure. The most serious complication of endocarditis is the spread of rheumatic fever to other regions and organs.

This can lead to complications such as acute polyarthritis and chorea minor. If the course is severe, multiple organ failure with a fatal outcome is possible. If the inflammation is treated early, there are usually no major complications. However, antibiotics and anti-inflammatories are not free from side effects. Corresponding preparations can cause headaches, muscle and body aches, skin irritations and gastrointestinal complaints.

Allergies and symptoms of intolerance can also occur. If cortisone is administered, this can lead to an increase in blood fat, blood pressure and blood sugar. Possible late effects are osteoporosis or the so-called Cushing’s syndrome. Heart surgery is always risky and can cause complications such as bleeding, abnormal heart rhythms and heart failure. Inflammation of the heart is life-threatening and constitutes a medical emergency that is accompanied by other symptoms.

When should you go to the doctor?

With any form of endocarditis, it is important to go to the doctor quickly. Because without treatment, it can only get worse. As soon as the first symptoms appear, it is therefore advisable to go to the family doctor. A general practitioner will recognize the signs of post-infectious endocarditis. He can distinguish heart inflammation from other diseases with similar symptoms. If there is a high fever, he can already prescribe antibiotics. In addition to a general examination, the family doctor will carry out the first special tests. If the results point to endocarditis, then he will refer the patient to a heart specialist (cardiologist) as an urgent case.

He carries out more precise tests and starts the targeted treatment as quickly as possible. Undetected or untreated, the disease is often fatal because there is an acute risk of heart attack. A stroke, pulmonary or renal embolism can also result from untreated heart inflammation. If postinfectious endocarditis persists for too long, the heart valves can become permanently damaged. In this case, an operation is necessary.

Treatment & Therapy

Rheumatic endocarditis is primarily treated with antibiotic therapy (penicillin, but also macrolides) in order to kill any bacteria that may still be in the body.

At the same time, the rheumatic complaints are treated with pain-relieving and anti-inflammatory drugs such as acetylsalicylic acid while at the same time protecting the body, especially the heart. In the case of pronounced rheumatic endocarditis, glucocorticoids and immunosuppressants are also used to reduce the overreaction of the immune system. If rheumatic endocarditis leads to severe heart valve damage due to the inflammatory changes, surgical intervention (valve replacement) may be necessary.

In addition, after rheumatic endocarditis, antibiotic therapy is continued prophylactically as part of long-term therapy (usually monthly antibiotic injections) for the following five years. After the rheumatic endocarditis has subsided, a thorough cardiological examination should be carried out in order to rule out possible damage to the heart valves or to be able to treat them at an early stage.

In order to prevent further inflammation of the pharynx, an tonsillectomy is also recommended. Endocarditis prophylaxis is recommended for those affected by rheumatic endocarditis before surgical and dental interventions.

Prevention

Since rheumatic endocarditis is caused by an immunological dysregulation as a result of a streptococcal infection, preventive measures are aimed at early and consistent therapy of inflammatory diseases caused by streptococci, such as tonsillitis (tonsillitis), scarlatina (scarlet fever) or otitis media (middle ear infection). Endocarditis prophylaxis before surgical or dental interventions also serves to prevent streptococcal infection and thus rheumatic endocarditis.

Aftercare

Rheumatic endocarditis (post-infectious endocarditis) is a bacterial autoimmune secondary disease. In principle, follow-up care with complete healing is possible. As there is a risk of heart valve failure with this disease, rapid follow-up care is very important. Taking antibiotics is essential. Care should be taken to ensure that it is taken correctly and regularly.

In particularly severe cases, additional intake of cortisone is necessary. Treatment with anti-inflammatory drugs such as acetylsalicylic acid is also recommended to relieve possible pain. In order not to put additional strain on the body and especially the heart, stress and physical work should be avoided and, in severe cases, bed rest should be observed.

After the illness with rheumatic endocarditis (post-infectious endocarditis), regular follow-up examinations are important in order to observe the healing process and, if necessary, to initiate further drug therapy. If the course is positive, rheumatic endocarditis (post-infectious endocarditis) has healed after one to two months.

However, the prognosis depends very much on when the disease is detected and whether the heart valve has been severely damaged. In severe cases, this can lead to chronic changes in the heart valve and, in extreme cases, require surgical intervention.

You can do that yourself

Rheumatic endocarditis is amenable to self-help but requires treatment by specialists such as internists or cardiologists. Self-help in everyday life refers on the one hand to the acute illness, on the other hand to aftercare and preventing a possible recurrence of the illness.

Rest is an important factor with regard to the acute illness. The patient’s cooperation is crucial here. Physical exertion and sports are to be avoided until they are permitted again by the doctor. Inflammation of the body can often be positively influenced by getting enough sleep and drinking plenty of fluids. Water and herbal teas are particularly recommended here. Nicotine and alcohol should be avoided. Protection against wind and weather is also important in order not to burden the body’s weakened immune system.

Self-help is still possible after surviving rheumatic endocarditis. On the one hand, to build up fitness again in a targeted manner. This is best done in consultation with the family doctor or a specialized sports therapist to find the right stress dose. Since rheumatic processes can also be specifically influenced by a healthy diet, it makes sense to change these as well. Mediterranean food with lots of fruit and vegetables instead of meat and sausage makes sense in this context. Drinking enough water is always important.

Rheumatic Endocarditis (Post-infectious Endocarditis)