An inflammation of the connective tissue endocardium is usually the result of a bacterial infection. It often affects children and adolescents and can lead to serious heart valve damage. The endocardium (Endo = inside, and kard = heart-related) is the connective tissue structure of the heart interior and also forms the heart valves. By the pumping action of the heart muscle and the resulting blood flow, the floating parts of the endocardium act as the valves of an engine in constant motion and as such are exposed to so severe mechanical stresses.
Inflammatory processes of the endocardium, which is called endocarditis, can cause severe scarring, adhesions and function limitations of the heart valves – with far-reaching effects on the performance of the heart muscle, and thus the circulatory function. An acute endocarditis is potentially life-threatening – and is fatal in about 15% of cases.
Most endocarditis is produced either as a failure of the immune response after a streptococcal infection (rheumatic endocarditis) or in inflammatory processes, which are caused by microbes (infective endocarditis). Most commonly the mitral valve is affected, which is the valve between the left atrium and ventricle heart.
Rheumatic endocarditis often affects not only the endocardium, but the entire heart muscle (myocardium) and cardiac outer layer (pericardium). It can also be triggered by a pre-existing infection with from a specific bacterial pathogen type. A dis-regulation of the immune system can then lead to an excessive reaction of the immune response, where disease-causing pathogens are not targeted, but the body’s own tissue is attacked – in this case the endocardium, and in particular the heart valves. This reaction is considered an autoimmune disease.
In rare cases other diseases can such a non-infectious (nonbacterial) endocarditis trigger. These can cause inflammation of the connective tissue throughout the body – and thus to inflammation of the connective tissue heart valves. These include, for example, rheumatoid arthritis, Bechterew’s disease and lupus erythematosus.
In contrast, the inflammation of the valve tissue is directly triggered by bacteria in infectious endocarditis, which settle in the area and multiply (bacterial endocarditis). In addition, fungi can cause endocarditis.
Rheumatic endocarditis is more common in children and adolescents than in adults. Bacterial endocarditis can manifest very suddenly (acute form), and within a short time high fever, weakness and joint problems, some lesions (small hemorrhages) and shortness of breath may result. The more common (subacute) form has more slowly developing non-specific symptoms such as tiredness, fatigue, reduced performance, low-grade fever, night sweats or a decrease in hemoglobin.
Longer-term endocarditis may cause symptoms of heart failure. If endocarditis is diagnosed too late, the damage to the heart valves can be irreparable (chronic course).
Posted in: Cardiology Health Basics