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Infective endocarditis is the presence of a microbial infection on the endocardial surface (the inner surface of the heart). It is the most common cardiovascular infection and is highly significant due to its potential severity and the fact that it can present in different clinical forms.
Infective endocarditis primarily affects the heart valves, whether natural or artificial, although it can sometimes involve other structures of the heart. It is classified according to the duration of the infection (days, weeks, or months) and the type of causative microorganism (bacteria, yeast, or fungi).
The characteristic lesion of infective endocarditis is the endocardial vegetation. This consists of an abnormal aggregate of platelets, fibrin, bacteria, and inflammatory cells that adheres to the inner surface of the heart—typically a heart valve—and can detach, causing infectious emboli in distant organs such as the skin, nervous system, or extremities.
It is considered a serious disease. Although most cases are curable, it carries significant complications and mortality even with treatment. In many cases, achieving a definitive cure requires surgical intervention to remove affected tissue and replace the valve with an artificial one.
In the acute form, infective endocarditis may cause high fever, chills, prostration, and rapid deterioration of general condition over hours or days.
In subacute forms, with progression over weeks or months, the main symptoms are fatigue, loss of appetite, and mild fever. In these cases, characteristic skin lesions, such as nodules or spots, may also occur, although not always.
In patients with severe valve involvement, valvular dysfunction may develop, resulting in heart failure symptoms, such as significant shortness of breath and edema in the lower limbs.
Infective endocarditis has a global incidence of 2–3 cases per 100,000 people per year. In Catalonia, around 200 new cases are diagnosed annually. Its incidence increases significantly with age, reaching 15–30 cases per 100,000 people per year in individuals over 65—about 10 times higher than in younger populations.
The causative agents have changed over recent decades. Previously, streptococci, particularly viridans streptococci, were the most common. Currently, the most frequent pathogens are staphylococci, followed by streptococci and enterococci. However, any microorganism present in the blood can adhere to a heart valve, especially if it is previously damaged or artificial.
Diagnosis is primarily based on:
-blood cultures: to identify the causative microorganism and guide selection of the appropriate antibiotic therapy.
-echocardiography: to locate endocardial vegetations, assess valve function, and determine the need for surgery in certain patients.
In some cases, additional imaging (CT scans, nuclear medicine scans) is necessary to detect peripheral emboli, which are common at diagnosis or during treatment.
Treatment of infective endocarditis is antibiotic therapy, specifically targeted at the causative microorganism. Doses are high and prolonged, because vegetations are poorly vascularized and the antibiotic must penetrate by diffusion from circulating blood.
Patients who do not respond adequately to antibiotic therapy, or who develop significant valvular damage, may require valve replacement surgery.
Blood cultures and echocardiography, both at diagnosis and during follow-up, to monitor disease progression.
In individuals with known valvular abnormalities, antibiotic prophylaxis is recommended before dental procedures or gum surgery, following specialist guidance.
Preventive measures should also be taken during endoscopic procedures, especially upper gastrointestinal endoscopy (gastroscopy), according to the prescribed antibiotic regimen.
This prevention is crucial because the presence of bacteria in the bloodstream during such procedures significantly increases the risk of infective endocarditis.
It is a test that makes it possible to assess the anatomy of the heart and the coronary arteries, as well as to study how they function and to carry out certain treatments. This test is performed in a cardiac catheterization laboratory. Cardiac catheterization consists of inserting catheters that reach the heart in order to evaluate its anatomy, the coronary arteries, and its function, measure the pressure in the cardiac chambers, and determine whether any heart valve is altered. In addition to allowing the diagnosis of certain heart diseases, it makes it possible to detect congenital heart defects, atrial or ventricular communications, measure oxygen levels in different areas of the heart, and perform biopsies.
Cardiac catheterization is used to diagnose certain heart diseases, but also to treat some of them.
The treatments that can be performed with cardiac catheterization include:
Placement of stents in coronary arteries that have narrowed or become obstructed
Closure of blood vessels that did not close before birth, known as a patent ductus arteriosus
Implantation of aortic prostheses
Implantation of prostheses to treat heart defects present from birth, some of the so-called congenital heart diseases
This procedure is carried out in the cardiac catheterization laboratory, where the patient must remain very still throughout the intervention, lying on the examination table.
Before starting the catheterization, the area is disinfected—either the groin (femoral artery/vein) or the wrist. Then, a puncture is made with local anesthesia, and the catheter is introduced through the mentioned access points until it reaches the heart. A contrast agent is injected through the device.
Using radiologic equipment, the correct placement of the catheters is checked, and the healthcare professionals can visualize the arteries, veins, and heart chambers, assess their function, and, if necessary, implant intracoronary prostheses, stents, or other devices.
Once the examination is completed, a compression system is applied to the puncture site.
Bruising is common, and less frequently bleeding at the puncture site, pain, chest angina, or arrhythmias may occur, as well as abdominal bleeding if the catheter is introduced through the groin.
Cardiology, General Hospital
The Inherited Heart Diseases Unit of the Cardiology Department is primarily dedicated to patient care. This Unit specialises in managing all types of heart muscle diseases, focusing on inherited ones.
This unit treats heart diseases involving the myocardium, where the heart muscle becomes weakened, enlarged, or has another structural issue. Often, this prevents the heart from pumping blood effectively or functioning correctly. As inherited heart diseases are relatively rare, they require specialised management, which goes beyond the expertise of a general clinical cardiologist. It is necessary to have specific treatments and access to appropriate technology.
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