Endocarditis

What is endocarditis and how does it impact people who use drugs?

Endocarditis is a condition that causes the heart’s lining, valves, and muscles to be inflamed, or swollen. It’s caused when bacteria enters into the bloodstream from an open wound in the body, and then enters the heart from the bloodstream, and reproduces in the heart’s lining.

Because bacteria can live on or in a shared/used syringe, a shared/used cooker, used cottons saved for cotton shots, and other injection supplies, people who inject drugs are at risk for developing endocarditis. Bacteria that can cause endocarditis can also enter our bodies through open wounds like abscesses or cuts, via eating or drinking contaminated food, and/or through open wounds or cuts on our gums or in our mouths.

How do I know if I have endocarditis?

Unfortunately, endocarditis can develop slowly over time, and its early symptoms might feel like other infections or illnesses, like the flu. Some of those early symptoms include:

• Nausea

• Fever and chills

• Pale skin

• Weight loss

• A cough, or shortness of breath

So if you have these symptoms, and they’re continuing for more than a week, it’s a good idea to try to see a doctor.

Sometimes, people have symptoms that are more unique to endocarditis, like:

• A heart murmur, or a whooshing or rasping sound during your heartbeat

• A pained, bloated, or full feeling in the upper

left abdomen

• This is because your spleen -- which sits behind and slightly above your stomach, under the left side of your chest -- can swell as a result of endocarditis.

• Your upper left abdomen, or spleen, feeling tender or painful to touch.

• Small red (in lighter skin tones) or purple (in darker skin tones) dots or spots in places like the cheeks, the roof of your mouth, your chest, the whites of your eyes, or on extremities like fingers and toes -- these are from ruptured capillaries.

These are pretty good indications that you need to see a doctor -- because even if it’s not endocarditis, it could be another heart or spleen condition.

I think I might have a heart murmur, is there any way I can tell for sure?

Heart murmurs are complicated, and aren’t always a sign that you have endocarditis or heart problems (sometimes people get them during pregnancy, for example), but in addition to a whooshing or rasping sound, some symptoms to look out for are:

• Chest pain

• Poor circulation -- which might be indicated by blue or gray fingertips or lips, or chills

• Swollen liver (located above stomach to the right of the spleen)

All this said, only your doctor can diagnose a heart murmur. They will use a stethoscope to listen to your heart and see if it’s beating abnormally. To be clear, this is how they tell if you have a heart murmur -- not if you have endocarditis.

So how is endocarditis diagnosed?

Diagnosing endocarditis can be a complicated process, so be prepared for lots of steps. Here is what you might expect:

1. Your doctor will listen for a heart murmur, and then,

2. A blood test might be done, to see if there is any bacteria or infection in the blood.

3. The doctor may order an echocardiogram, or imaging of your heart, so they can better see your heart and its valves. There are two types of echocardiograms:

• A transthoracic echocardiogram uses a probe put on the outside of your chest and ultrasound waves to make a picture of your heart and give your doctor a look at its movements.

• A TEE (transesophageal echocardiogram) looks at your heart through your esophagus, so the probe would be put inside your body through your mouth. This can give the doctor an even better view of your heart and its walls.

4. An EKG machine might be used to test your heart’s electrical activity. During an EKG test, about a dozen soft electrodes leading to the EKG machine will be attached to your skin. The machine will gauge whether your heart rate is abnormal.

5. Your doctor also might also order a chest x-ray to make sure you don’t have a collapsed lung or fluid in your lungs -- these conditions have similar symptoms to endocarditis.

Using some combination of these tests, your doctor will listen for an abnormal heart rate and look for inflammation in your heart’s lining, valves, and muscles. From there, they will determine whether you have endocarditis.

How will they treat endocarditis if I do have it?

Endocarditis is usually treated with antibiotics to fight and eliminate the bacteria, starting with IV antibiotics. It’s typical for people with endocarditis to be in the hospital receiving IV antibiotics for a week or more, depending on how severe the infection and/or inflammation is. Later, your doctor may transition you to oral antibiotics. It isn’t unusual for people who have endocarditis to be on antibiotics for up to six weeks, and it’s really important that you take the entire prescribed course of antibiotics to fight the bacteria.

Depending on how long someone has had endocarditis and how serious the infection is,

sometimes surgery is recommended. Often, surgery is used to remove dead or scarred tissue in the heart or address fluid buildup. Sometimes, people also need to have one or more (there are a total of four) heart valves replaced. The recovery time from these surgeries varies, but you should be able to go home from the hospital within three days if you don’t require additional treatment.

Can endocarditis come back? How can I prevent it going forward?

Yes, you can get endocarditis again. Unfortunately, people who have had endocarditis once are more likely to get it again. Here are some tips for preventing endocarditis:

• Use a new sterile syringe and other injection equipment every time you inject

• Don’t do cotton shots (bacteria can grow on old cottons), or at least freeze cottons before reusing them to kill bacteria

• Take care of your oral hygiene! Bacteria can easily enter the bloodstream through small openings in your gums and other parts of your mouth.

• Keep wounds like abscesses, cuts, and scrapes covered until fully healed.

Resources

• https://www.healthline.com/health/endocarditis

• https://www.heart.org/en/health-topics/heartvalve-problems-and-disease/heart-valveproblems-and-causes/heart-valves-and-infectiveendocarditis

• https://www.healthline.com/health/heartmurmurs

• https://www.medicalnewstoday.com/ articles/151016

• https://www.pennmedicine.org/updates/blogs/ heart-and-vascular-blog/2015/october/4-mythsabout-heart-murmurs

• https://www.saintlukeskc.org/health-library/ understanding-heart-murmur

• https://www.heartandstroke.ca/heart-disease/ tests/transesophageal-echocardiogramtee#:~:text=A%20transesophageal%20 echocardiogram%20(TEE)%20is,the%20 structures%20of%20the%20heart

• https://www.heart.org/en/health-topics/ heart-attack/diagnosing-a-heart-attack/ transesophageal-echocardiography-tee

• https://www.heart.org/-/media/files/healthtopics/heart-valve-disease/heart-valve-surgerymilestones-checklist.pdf?la=en