Causes of endocarditis

Endocarditis is caused by bacteriain the bloodstream multiplying and spreading across the inner lining of your heart (endocardium). The endocardium becomes inflamed, causing damage to your heart valves.

Your heart is usually well protected against infectionso bacteria can pass harmlessly by. However, if your heart valves are damaged or you have an artificial valve, it's easier for bacteria to take root and bypass your normal immune response to infection.

Small clumps of bacteriacan develop at the site of the infection. There's a risk of these clumps acting ina similar way to Arterial thrombosis , travelling away from the heart and blocking the blood supply to the organs. This can cause organ failure or trigger a stroke .

How bacteria reach the heart

The most common ways that bacteria can enter your blood are explained below.

Mouth

Everyday activities, such as brushing your teeth or chewing your food, can sometimes allow bacteria to enter the bloodstream. The risk is increased if your teeth and gums are in bad condition, because it makes it easier for bacteria to enter.

Infection

Bacteria can spread from the site of a pre-existing infection, such as a skin infection or a gum infection .

Bacteria can also enter your body as a result of a sexually transmitted infection (STI) , such as chlamydia or gonorrhoea .

Needles and tubes

Any medical procedure that involves placing a medical instrument inside the body carries a small associated risk of introducing bacteria into your bloodstream.

Instruments that have been linked to endocarditis include:

• syringes
• catheters a tube used to drain the bladder
• the tubes used during dialysis a treatment that involves replicating the functions of the kidneys
• laparoscopes a small, flexible tube with a light source and a camera at one end, used to help diagnose a wide range of conditions

Whos at risk

There are a number of things that can make your heart more vulnerable to infection and increase your chances of developing endocarditis. These are discussed below.

Heart valve disease

Heart valve disease is a general term describing conditions that damage the valves of the heart. Two types of heart valve disease known to increase your risk of endocarditis are:

• valvular stenosiswhere the valve(s) of the heart become narrowed, disrupting the blood flow through the heart
• valvular regurgitation where the valve(s) of the heart don't close properly, causing blood to leak back in the wrong direction

Heart valve disease can be either:

• congenital where you're born with the condition
• acquired where you develop the condition in later life

Causes of acquired heart valve disease include:

• a previous heart attack a heart attack can damage the muscles that surround and support the valve, preventing the valves from functioning properly
• high blood pressure without treatment, high blood pressure (hypertension) can weaken the tissue around the valves
• rheumatic fever a type of bacterial infection that can damage the heart

Rheumatic fever is raresince theintroduction of antibiotics. However, older people who had rheumatic fever during childhood may go on to develop heart valve disease.

Prosthetic valves

Prosthetic (artificial) valves are used to replace heart valves that have beendamaged by heart valve disease.

However, bacteria can also take root around prosthetic valves, which can occasionally trigger endocarditis. This risk is relatively low,estimated to be less than one in 100.

Hypertrophic cardiomyopathy

In hypertrophic cardiomyopathy , the heart muscle cells have enlarged and the walls of the heart chambers thicken. The chambers are reduced in size so they can't hold much blood, and the walls can't relax properly and may stiffen.

Hypertrophic cardiomyopathy is thought to affect 1 in 500 people in the UK.

Intravenous drug use

People who habitually inject illegal drugs such as heroin or methamphetamine (crystal meth)into their veinshave an increased risk of developing endocarditis.

This is because unsterilised needles allow bacteria to enter the bloodstream and repeated injections make the skin more vulnerable to infection.

Fungal endocarditis

Endocarditis caused by a fungal infection is rarer than bacterial endocarditis, and usually more serious. You're more at risk of fungal endocarditis if you:

• inject drugs
• have a history of heart surgery
• have a central venous catheter a tube connected to a vein in the neck, groin or chest, which is used to deliver medicines and/or fluids to people who are seriously ill
• have a weakened immune system either as a result of a condition affecting the immune system, such as HIV , or as a side effect of certain types of treatments, such as chemotherapy

Acute

Acute means occurring suddenly or over a short period of time.

Bacteria

Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and some others are good for you.

Blood

Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.

Brain

The brain controls thought, memory and emotion. It sends messages to the body controlling movement, speech and senses.

Chemotherapy

Chemotherapy is a treatment of an illness or disease with a chemical substance, for example in the treatment of cancer.

Fever

A high temperature, also known as a fever, is when someone's body temperature goes above the normal 37C (98.6F).

Heart valve

Heart valves are four sets of flaps that control the direction that blood pumps around the heart.

Immune

The immune system is the body's defence system, which helps protect it from disease, bacteria and viruses.

Intravenous

Intravenous (IV) means the injection of blood, drugs or fluids into the bloodstream through a vein.

Kidneys

Kidneys are a pair of bean-shaped organs located at the back of the abdomen, which remove waste and extra fluid from the blood and pass them out of the body as urine.

Lungs

Lungs are a pair of organs in the chest that control breathing. They remove carbon dioxide from the blood and replace it with oxygen.