Rheumatic Endocarditis Vegetations: Understanding The Risks And Treatment Options

Rheumatic heart disease can lead to several complications, one of which is infective endocarditis. Although the term "rheumatic endocarditis" is sometimes used colloquially, the medical community typically refers to this condition as infective endocarditis. It occurs when bacteria or other infectious agents enter the bloodstream and attach to damaged areas of the heart valves, leading to the formation of abnormal growths known as vegetations.

How Common Is Infective Endocarditis?

In recent years, the incidence of infective endocarditis has increased, partly due to factors such as intravenous drug use, poor dental hygiene, and delayed medical care. Cases have been reported in patients ranging from their early 20s to late 50s. A common clinical presentation is unexplained fever that persists for weeks despite antibiotic treatment. Patients often visit local hospitals and receive multiple types of antibiotics without any improvement in symptoms.

Signs And Symptoms To Watch For

When a patient presents with persistent fever of unknown origin, physicians should consider the possibility of cardiac involvement. A routine echocardiogram can reveal vegetations—floating masses or clumps attached to heart valves. In healthy individuals, heart valves are smooth and free of such growths. The presence of these abnormal structures strongly suggests infective endocarditis.

Why Are Vegetations Dangerous?

Vegetations are clusters of bacteria, inflammatory cells, and fibrin that can lead to serious complications if not treated promptly. Here are the primary concerns:

1. Risk Of Stroke

Vegetations are fragile and can easily break off. If a piece travels to the brain, it can block a blood vessel and cause a stroke or cerebral embolism.

2. Systemic Infection And Abscess Formation

Detached bacteria can spread to other parts of the body, leading to metastatic infections such as abscesses in the brain, liver, or other organs. This systemic spread can significantly complicate the clinical course.

3. Valve Damage And Heart Failure

As the infection progresses, it can destroy heart valve tissue, leading to severe regurgitation or valve insufficiency. This can result in symptoms such as fatigue, shortness of breath, and fluid retention—hallmarks of heart failure.

Treatment And Management Strategies

Managing infective endocarditis requires a multidisciplinary approach involving both cardiology and cardiothoracic surgery. Treatment typically begins with prolonged courses of intravenous antibiotics tailored to the specific organism identified through blood cultures. In some cases, surgical intervention becomes necessary, especially if complications such as valve destruction, persistent infection, or embolic events occur.

Surgical Considerations

While there is ongoing debate regarding the optimal timing and indications for surgery, many centers now adopt a more aggressive approach. Delaying surgery can increase the risk of irreversible heart damage and mortality. Following international and national guidelines, our team prioritizes early surgical evaluation to improve outcomes and reduce complications.