Guide To The Symptoms Of Endocarditis
Endocarditis is the infection and inflammation of an individual's endocardium. The heart chambers have an interior surface covered by a special lining, called the endocardium, containing a layer of connective tissue and a layer of endothelial cells. Pathogens from anywhere within an individual's body can spread through their bloodstream and bind to damaged tissues in the heart. Without treatment, this type of infection can have serious complications, including permanent damage to the heart valves.
The most common ways pathogens enter the bloodstream and cause endocarditis include open wounds in the mouth, skin sores, sexually transmitted infections, venous catheter, body piercing needles, tattoo needles, intravenous illegal drug use, and some dental procedures. CT scans, chest x-rays, electrocardiogram, echocardiogram, and blood tests may be utilized in the diagnosis of endocarditis.
Muscle And Joint Aches
Over forty percent of endocarditis patients experience muscle and joint aches. Joint aches that result from endocarditis typically only affect one to three joints. This joint and muscle pain also manifests in a pattern that is not symmetrical. The pain complaints in such individuals are said to be similar to those observed in individuals affected by rheumatoid arthritis, Lyme disease, and Reiter's syndrome. This symptom occurs when the endocarditis causing pathogen mobilizes and attacks the synovial membranes and fluids of the joints. The pathogen colonizes in the synovial fluid that sits between the joints and summons an immunological response. This mechanism causes blood vessel dilation, redness, swelling, and inflammation in the affected joints.
When the synovial fluid becomes inflamed, the affected individual will experience sensations of pain because it cannot provide lubrication and protection to the bones. Joint and muscle pain are most commonly reported in endocarditis patients in their shoulders, knees, and back. In many patients, muscle and joint pain can be the first symptomatic manifestation of endocarditis. These pains can show up months before other symptoms, causing many physicians to overlook endocarditis as the underlying cause.
Night Sweats
An individual who experiences night sweats may be affected by endocarditis. The medical definition of night sweats is a drenching sweat that prompts the affected individual to change their pajamas and sheets several times per week. Night sweats occur as an adverse effect of numerous different types of infections, including endocarditis. An affected individual's immune system responds to the infection-causing pathogen in several ways. One way is to prompt the brain to adjust the body's internal thermostat to a higher baseline temperature. This mechanism is meant to make the environment inhospitable for the pathogen causing endocarditis or any other infection.
However, the body makes sure the high temperature does not become too high due to the serious consequences and damage an extremely high fever causes. When a patient with an infection has a fever that is becoming too high, the body initiates its cooling mechanism called sweating. This process involves the release of salt and water from the skin through the sweat glands. As the water dampens the skin, it is evaporated into the air. Heat accompanies the water evaporated from the skin, lowering the body's core temperature. These temperature fluctuations may occur several times during the night from endocarditis.
Heart Murmur
A new or changed heart murmur can indicate an individual has endocarditis. A healthy heart when listened to has two distinct sounds, a lub noise, and a dub noise. The lub sound is produced by the closing of the tricuspid and mitral valves. The dub sound is produced by the closing of the aortic and pulmonic valves. A heart murmur is an abnormal sound of swishing when listening to the heart. Abnormal or turbulent blood flow through or across a valve in the heart causes a heart murmur.
Endocarditis can progress quickly and severely, or it may progress slowly and subtly. Many forms of acute endocarditis are caused by a direct pathogenic attack on a valve within the heart that rapidly causes damage to the previously normal valve tissue. Anytime a valve in the heart becomes damaged, the flow of blood through or across it becomes altered and produces an abnormal sound. A new heart murmur is most often associated with the acute forms of endocarditis, where a change in an existing heart murmur is most often associated with the subacute forms of endocarditis.
Swelling In The Feet And Legs
Endocarditis can produce swelling in the feet and legs of individuals affected by it. This symptom is common in individuals who had existing heart disease or conditions before developing endocarditis. Endocarditis causes the existing heart condition to progress or worsen, resulting in decompensated heart failure with obvious symptoms. Swelling in the feet and legs or peripheral edema occurs when the heart begins to fail. Blood moves through the veins in the body back to the right chambers of the heart. It moves through the lungs and back through the left chambers of the heart before it is then pumped back around the body.
When endocarditis causes damage to the heart that results in reduced function, the blood in the veins can get backed up because the right side of the heart is unable to keep up. Excess blood can settle in the veins of the feet and legs, eventually forcing fluids out of the vessel walls into surrounding tissues. This excess fluid in the tissues is called edema, and it occurs in the lower peripherals due to the force of gravity. Swelling in the feet and legs is typically not one of the first symptoms to manifest in an endocarditis patient.
Fever And Chills
Most individuals affected by endocarditis experience a fever and chills. There are two main reasons why this commonly appears in individuals with infections like endocarditis caused by harmful pathogens. Bacteria, viruses, fungi, and parasites have different preferences when it comes to their environment and how well they can thrive in it. Some pathogens cannot perform their reproductive and colonization functions in a hyperthermic environment. The body implements this defense mechanism to all pathogens that are in the process of making the body their new home.
Not only does this help create an environment where the pathogen has trouble reproducing, but it has also been shown to have certain influences on the immune system components themselves. White blood cells called T-cells are part of the immune system and work to destroy other cells that are malignant or infected by pathogens. Recent studies have proven a hyperthermic environment enhances the activity of these T-cells. It is the immune system signaling the brain to raise the core temperature of the body that causes patients to have a fever and chills.
Pale Skin
Endocarditis is a type of infection where bacteria attach to the inner valves of an affected individual's heart muscle. A heart valve is a flap of tissue that opens and closes to regulate blood flow in the upper and lower chambers of the heart. An infection that develops on the leaflets of these valves in the heart can cause them to become inflamed and unable to do their job properly.
When the valves do not open and close when they should, the flow of blood through the individual's heart becomes impaired. As a result of this malfunction, blood flows backward or regurgitates into the prior chamber or blood can experience a decrease in flow when the leaflets of the valve become too stiff to open all the way. When the heart cannot pump enough oxygenated blood through the body properly, the individual will experience a pale color to their skin because of the way oxygen-poor blood reflects light.
Nausea
An individual affected by a form of endocarditis called subacute endocarditis may experience nausea, a sensation where an individual feels they need to vomit. Vomit is the forceful movement of food from the stomach to the outside of the mouth. Vomiting is a mechanism in the body that attempts to remove the source of toxicity when the levels of toxins in the blood become too high. Endocarditis can cause patients to develop clots of debris in their circulation.
These emboli that float around in the bloodstream of an individual with endocarditis eventually make it to the kidneys where impurities are filtered out of the blood. The emboli become lodged in the blood vessels of an affected individual's kidneys, stopping the flow of blood to the kidney tissues. This obstruction of oxygen-rich blood to the kidney tissues causes areas of infarction or cells that shut down due to oxygen deprivation. This causes the kidneys to work poorly and allows toxins to build up in the blood, which is what produces nausea.
Unintentional Weight Loss
Weight loss occurs when an individual's energy balance ratio becomes negative instead of neutral or positive. An individual's energy balance is the number of calories they take in comparison to the number of calories their body burns. An individual will gain weight when they are taking in more calories than they are burning off (positive energy balance). An individual will lose weight when they are consuming fewer calories than their body is burning off (negative energy balance). Cells around the body use calories by converting them into usable cellular energy.
A healthy individual's body will be able to maintain a neutral energy balance on a healthy diet, but an individual affected by any form of infection is going to burn more calories than someone who does not have an infection in their body. This negative energy balance occurs in endocarditis because the bacteria causing the heart infection need calories and glucose to carry out their functions the same way healthy cells in the body do.
Shortness Of Breath Or Coughing
Endocarditis develops when bacteria attach to vulnerable parts of the heart tissue and colonize. The valves of the heart are the most affected structures in the heart by bacterial endocarditis. Subacute endocarditis causes the tissues that make up the leaflets in the heart to become damaged to the point where the body initiates the mechanism used to repair damaged tissues. When this process occurs frequently over time, scar tissue begins to build on the valve leaflets because damaged tissue is replaced with dense and fibrous tissue.
The buildup of fibrous scar tissue on the valve leaflets causes them to be unable to open properly. If this scar tissue from endocarditis builds on one of the pulmonary valves, it can cause blood to back up into the lungs. When blood backs up in the lungs it causes pulmonary hypertension, which produces symptoms like coughing and shortness of breath.
Blood In The Urine
Most individuals affected by blood in the urine (hematuria) due to endocarditis are affected by subacute endocarditis that has developed over time. The emboli that form in an affected individual's blood due to the infection in their heart become lodged in the kidneys and can cause sections of the kidney tissue to shut down or die. This damage to the kidney tissues is the result of infarcts in the organs due to an obstruction of oxygenated blood.
When the infection in an individual's heart moves to their kidneys, it can cause them to develop a condition referred to as interstitial nephritis. Interstitial nephritis causes the tissues of the kidneys to swell and become damaged, which can leak blood into the urine. If an individual's endocarditis is caused by an infection with streptococcus bacteria, they can develop an infection in the kidneys called proliferative glomerulonephritis.