Endocarditis causes vegetative matter to grow in the valves of the heart, generally the pulmonary and aortic valves. Endocarditis may also occur in the mitral and tricuspid valves, though this is less common. In most cases, the cause of endocarditis is bacterial, and most often it affects those with valve anomalies or with surgical repairs of the heart. Some conditions may also cause endocarditis, though this is much rarer.
The risk of developing endocarditis is that it can cause congestion and/or damage to the affected valves. Where a great deal of vegetative matter has grown, valves may not be able to get blood through the heart, or to the lungs or body, depending upon location. This can lead to heart failure, and to death, when it is untreated. Additionally, clogged valves can result in blood clotting, which can then result in stroke if clots reach the brain.
Treatment itself may involve risk. In some bacterial endocarditis cases, treatment for four to six weeks with antibiotics will kill vegetative matter. In other cases, surgery may need to be performed to remove the matter, or to replace valves that are so clogged they can no longer function.
Since endocarditis is more frequent in those who have undergone surgery or who have congenital defects, surgery carries a higher risk. Further, likelihood of developing endocarditis is increased because surgery can create scar tissue to which bacteria can readily attach.
Non-bacterial endocarditis can occur in anyone, and may occur in people who are perfectly healthy in all other respects. However, most cases of non-infective endocarditis result from underlying conditions, like cancer or lupus. Treatment depends upon the likelihood of curing the underlying condition. In lupus for example, treatment undertaken would probably be surgery. However, since people with lupus are more prone to infection, any surgery is more risky. With incurable cancers, no treatment may be undertaken.
Though bacterial endocarditis is most closely linked to identifiable risk groups, some may be more susceptible to bacterial endocarditis without being aware of risk. Those who have suffered from rheumatic fever may have heart damage that does not inhibit function but does pose greater risk. Mitral valve prolapse, which is frequently not identified until the teen years or later, may pose a silent risk for endocarditis.
Risk of developing endocarditis is greatest when one receives a significant mouth injury or undergoes dental procedures. Since two of the most common bacteria, strep and staph, may be present in the mouth, they can readily enter the bloodstream due to small cuts in the mouth. Those who are aware of being in a high risk group need to take antibiotics prior to any type of dental procedure, and should inform dentists prior to any dental work.
In most cases, a single large dose of antibiotics, taken an hour prior to a dental procedure, even if the procedure is minimal like a cleaning, will prevent bacterial endocarditis in those who are at higher risk. Those who have heart murmurs should probably get confirmation that the murmurs are not the result of underlying defects prior to undergoing dental procedures. As well, history of rheumatic fever should warrant a visit to a cardiologist to rule out development of endocarditis or damage to the heart.
