Rheumatic Endocarditis Vegetations: Understanding the Condition and Its Risks
When discussing heart-related complications of rheumatic diseases, one topic that often arises is the presence of vegetations on heart valves. While the term "rheumatic endocarditis" may occasionally appear in medical discussions, the more commonly accepted clinical term is "infective endocarditis." This condition involves the formation of abnormal growths, known as vegetations, on the inner lining of the heart or heart valves.
How Infections Reach the Heart
In recent years, the number of patients diagnosed with infective endocarditis has increased, particularly among individuals with risk factors such as intravenous drug use, poor dental hygiene, or delayed medical care. Cases have been reported in patients ranging from their early 20s to late 50s. A key symptom is the sudden onset of unexplained fever. Many patients visit local hospitals and receive multiple courses of antibiotics over a period of 10 to 20 days without any improvement in symptoms.
Why Early Diagnosis Matters
When a fever persists despite treatment, it's important to consider heart-related causes. A standard echocardiogram should be part of the diagnostic process. Echocardiographic imaging often reveals unusual masses or fibrous material attached to the heart valves. In a healthy heart, the valves are smooth and free of such formations, so the presence of these growths raises a strong suspicion of vegetations.
What Are Vegetations?
Vegetations are clumps of bacteria, inflammatory cells, and fibrin that accumulate on the surface of heart valves. These abnormal growths can lead to several serious complications:
Key Risks Associated With Vegetations
1. Risk of Stroke: Due to their fragile nature, vegetations can easily break loose and travel through the bloodstream. If a piece reaches the brain, it can block blood flow and cause a stroke or cerebral embolism.
2. Systemic Infection and Abscess Formation: Detached vegetations may carry bacteria to other organs, leading to widespread infection and the formation of abscesses in distant parts of the body.
3. Valve Damage and Heart Failure: As vegetations grow, they can erode heart valves, leading to severe regurgitation or valve dysfunction. This can result in symptoms such as persistent fever, fatigue, shortness of breath, and signs of heart failure.
Treatment Options and Medical Management
Managing infective endocarditis requires a multidisciplinary approach involving both cardiology and cardiac surgery. The foundation of treatment is long-term antibiotic therapy guided by blood culture results. Additionally, comprehensive echocardiographic monitoring is essential to assess the size and stability of vegetations.
In some cases, surgical intervention becomes necessary. Although the timing and criteria for surgery remain topics of debate in the medical community, many centers, including ours, follow a more aggressive approach based on both international and national clinical guidelines. Delaying surgery can significantly increase the risk of life-threatening complications, making prompt intervention crucial for better outcomes.