Treatment of Infective Endocarditis

 

Treatment of endocarditis

The main goals of treatment of infective endocarditis are to address complications caused by valvular infection and to eradicate microbial agents from the thrombus. Some of the consequences of infective endocarditis may require surgical treatment.

General measures for stabilizing the patient include:

  • Oxygen reduces the hypoxia, supporting the function of the heart. This can potentially reduce the damage that the heart may sustain as a result of hypoxia.
  • Treatment of heart failure – involves the use of the right combination of medications (including angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, digoxin, beta blockers, diuretics, aldosterone antagonists, and inotropes) and, in some cases, the use of special devices that help the heart contract properly.
  • Hemodialysis – this method is used for patients with renal failure, which can occur as a result of embolization of the renal arteries or due to septicemia.

Antibiotic therapy

After the blood cultures are made (usually 3 to 5 sets of blood cultures done within 60-90 minutes) and the microorganism that caused infective endocarditis is identified, an antibiotic therapy, tailored to the patient, can be started.

However, in case of acute infective endocarditis, waiting can result in serious complications, which is why empiric antibiotic therapy is chosen based on the physical examination and clinical history. This way the doctors can determine the most likely infecting organisms. For example, patients who have a history of intravenous drug abuse are often infected by Staphylococcus aureus. Patients with prosthetic valves often have methicillin-resistant Staphylococcus aureus or coagulase-negative staphylococci.

On the other hand patients with subacute infective endocarditis can safely wait until the sensitivity results are available, as this doesn’t increase the risks of complications.

Intravenous administration of antibiotics is a preferred method, since it allows creating more reliable therapeutic levels of antibiotics within the bloodstream.

Surgical treatment

About 15-25% of the patients with infective endocarditis require surgery.

Indications for surgical treatment include:

  • Congestive heart failure that is resistant to standard medical therapy.
  • Fungal infective endocarditis (except for the one caused by Histoplasma capsulatum) – since this type of infective endocarditis is very resistant to drug therapy.
  • If sepsis persists after 72 hours of appropriate antibacterial therapy.
  • Recurrent septic emboli (especially if 2 weeks have passed after the antibiotic treatment).
  • Rupture of an aneurism in an aortic sinus.
  • Damage to the electrical conduction system of the heart by a septal abscess.
  • Intracardiac fistula and paravalvular abscess – in most cases require surgical treatment.
  • Persistent hypermobile vegetations create a risk of embolization and should be treated surgically.
  • Infective endocarditis caused by multiresistant microorganisms is also in the majority of cases an indication for surgery.
  • Patients who developed infective endocarditis as a result of pacemaker installation. In some cases this condition can be treated using drugs alone. However, in the majority of cases this type endocarditis can only be treated if the whole system is removed. According to American Health Association 2010 Guidelines, infections of cardiovascular implantable electronic device (CIED) can be treated and managed only through complete removal of the infected CIED. After the removal of the device, using a temporary transvenous pacer is the best option. However, immediate implantation of a permanent pacemaker can also be achieved. Moreover, AHA 2010 guidelines recommend careful evaluation whether the patient still requires CIED. If blood cultures were positive before the removal of the device, it is recommended to wait at least 72 hours after receiving negative blood cultures before installing a new pacemaker.

 Removal of CIED should be done in the following cases:

 o   Patients with valvular endocarditis or sepsis.

 o   Patients with abscess formation, skin adherence, or device erosion.

Prevention

In about 15-25% of infective endocarditis is the result of invasive procedures that cause a significant bacteremia. However, administration of pre-procedure antibiotics is only indicated in 50% of the cases, therefore only 10% of the cases of infective endocarditis can be prevented using antibiotics.

On the other hand, maintaining a good oral hygiene is a more effective method of prophylaxis, since gingivitis is one of the most common causes of spontaneous bacteremias.

Moreover, any form of diet doesn’t affect the progress of infective endocarditis in any way. The only reason why a person should adopt a diet with a lowered amount of sodium chloride is if infective endocarditis has led to congestive heart failure

 

Next Chapter: Endocarditis: Complications and Prognosis

 

 
 
Featured Articles

Can Depression Cause a Heart Attack?

Can Depression Cause a Heart Attack?

Heart disease and depression are both very serious and common conditions. They affect millions of people worldwide, and sometimes occur...

Does living in the mountains improve the health of…

Does living in the mountains improve the health of your heart?

Mountains have always been associated with the idea of strength, beauty and magnificence.  Many people consider mountains a symbol of...

Breathing Exercises for Your Heart

Breathing Exercises for Your Heart

Everyone knows how good morning exercises are for our body and health, but we know very little about the benefits...

Can You Die from a Heart Attack During Sex?

Can You Die from a Heart Attack During Sex?

Sex is an important part of most couple’s relationship and life. Therefore, it is not surprising that some people worry...

Rare Causes of Hypertension

Rare Causes of Hypertension

Most likely you’ve heard about a condition called hypertension or high blood pressure. Nowadays, it is very common in a...

The C-Reactive Protein

The C-Reactive Protein

Blood tests are a great way to learn many things about the patient’s state of health and make a correct...

How do Positive Emotions Impact the Heart?

How do Positive Emotions Impact the Heart?

There are a huge number of factors that determine and impact the heart's wellbeing. These include diet, physical activity, lifestyle,...

Is Our Generation More Susceptible to Heart Diseas…

Is Our Generation More Susceptible to Heart Diseases?

Despite all the advancements of modern medicine, the number of people affected by cardiovascular diseases in developed countries is on...

How Bacterial Pneumonia Damages the Heart

How Bacterial Pneumonia Damages the Heart

Bacterial pneumonia is an infection that affects one or both of the lungs. It creates an inflammation of the alveoli...

The Best Cardio Exercises For Your Heart

The Best Cardio Exercises For Your Heart

What is the driving force behind our lives? Certainly, exercise is one of the things that come to mind. Not...

Are Heart Problems Hereditary?

Are Heart Problems Hereditary?

Heart disease is currently the world's leading cause of death. Heart disease is not just one condition but a combination...

Computers: Can They Harm Your Heart

Computers: Can They Harm Your Heart

Most young and middle-aged people nowadays are working in offices equipped with computers and laptops. These people spend a tremendous...

10 Rules of Life for Patients with Varicose Veins

10 Rules of Life for Patients with Varicose Veins

The term “varicose veins” most commonly refers to the veins in the lower extremities because such veins mostly develop in...

Can Regular Consumption of Coffee and Energy Drink…

Can Regular Consumption of Coffee and Energy Drinks Damage the Heart?

At times, we all feel sleepy, tired, and devoid of energy - right after getting up in the morning, in...

Can Lack of Sleep Cause Heart Disease?

Can Lack of Sleep Cause Heart Disease?

Life in a big city is hectic with everyone hurrying somewhere, always being late and getting stressed due to the...

Are Women Less Susceptible to Heart Disease?

Are Women Less Susceptible to Heart Disease?

It is a well-known fact that women tend to live longer than men1. We may ask what is the reason...


To learn more about Cardiology, we recommend the following websites:

AHA-logoACC logoWHOwhf logowikipedia

ok