Inflammatory diseases of the heart

Endocarditis (Inflammation of the Heart’s Inner Lining & Valves)

Causes:

• Infective Endocarditis (IE) – Caused by bacteria or fungi, particularly in people with prosthetic valves, congenital heart defects, or IV drug use.
• Non-Infective Endocarditis – Associated with autoimmune diseases (e.g., lupus, antiphospholipid syndrome).

Symptoms:
• Fever, chills, night sweats
• New or worsening heart murmur
• Fatigue, weight loss
• Petechiae (small red/purple spots on skin or nails)
• Osler’s nodes (painful nodules on fingers/toes)
• Janeway lesions (painless red spots on palms/soles)

Complications:
• Heart valve damage → Heart failure
• Septic emboli → Stroke, kidney infarcts, pulmonary embolism

2. Myocarditis (Inflammation of the Heart Muscle)

Causes:

• Viral Myocarditis – Coxsackievirus, adenovirus, influenza, COVID-19, HIV.
• Bacterial Myocarditis – Lyme disease, diphtheria.
• Autoimmune Myocarditis – Sarcoidosis, lupus, giant cell myocarditis.
• Toxin-Induced Myocarditis – Alcohol, chemotherapy, cocaine, methamphetamine.

Symptoms:
• Chest pain (sharp, stabbing)
• Shortness of breath
• Palpitations, irregular heartbeat
• Flu-like symptoms (viral myocarditis)
• Heart failure symptoms (leg swelling, fatigue, dizziness)

Complications:
• Dilated cardiomyopathy → Chronic heart failure
• Arrhythmias → Sudden cardiac death

3. Pericarditis (Inflammation of the Heart’s Outer Layer)

Causes:

• Infectious Pericarditis – Viral (most common), bacterial (tuberculosis, staphylococcus), fungal.
• Autoimmune Pericarditis – Lupus, rheumatoid arthritis, scleroderma.
• Post-Cardiac Surgery Pericarditis (Dressler’s Syndrome) – Following a heart attack or heart surgery.

Symptoms:
• Sharp, pleuritic chest pain (worse when lying down, better when sitting forward)
• Pericardial friction rub (scratchy heart sound on auscultation)
• Low-grade fever
• Shortness of breath

Complications:
• Recurrent pericarditis (common after viral infections)
• Cardiac tamponade (fluid buildup compressing the heart, requiring urgent drainage)

Infectious Causes:

• Bacterial infections – Staphylococcus aureus (most common cause of infective endocarditis), Streptococcus viridans, tuberculosis.
• Viral infections – Coxsackievirus, adenovirus, influenza, HIV, COVID-19.
• Fungal infections – Candida, Aspergillus (rare but serious).

Non-Infectious Causes:

• Autoimmune conditions – Lupus, rheumatoid arthritis, sarcoidosis.
• Toxin exposure – Alcohol, chemotherapy, heavy metals, recreational drugs.
• Metabolic disorders – Uremia in chronic kidney disease.

Blood Tests:

• Inflammatory markers – CRP, ESR (detect inflammation)
• Cardiac markers – Troponin, BNP (indicate heart damage or failure)
• Blood cultures – Essential for diagnosing infective endocarditis

Imaging:

• Echocardiogram (Transthoracic & Transesophageal) – Detects valve damage, pericardial effusion, or reduced heart function.
• Cardiac MRI (for Myocarditis) – Detects inflammation and fibrosis in the heart muscle.
• Chest X-ray & CT scan – Checks for fluid around the heart (pericardial effusion).

ECG (Electrocardiogram):

• Pericarditis: ST-segment elevation across multiple leads (concave appearance).
• Myocarditis: Heart rhythm abnormalities.

Endocarditis Treatment

• IV Antibiotics (6+ weeks for bacterial endocarditis)
• Antifungal medications (for fungal cases)
• Surgical Valve Replacement (if severe valve damage occurs)

Myocarditis Treatment

• Supportive care (oxygen, diuretics, ACE inhibitors if heart failure develops)
• Steroids & Immunosuppressants (for autoimmune myocarditis)
• Antiviral therapy (if caused by a viral infection)

Pericarditis Treatment

• NSAIDs (e.g., Ibuprofen, Aspirin) & Colchicine (for viral or idiopathic pericarditis)
• Corticosteroids (Prednisolone) for autoimmune pericarditis
• Pericardiocentesis (if pericardial effusion leads to cardiac tamponade)

• Heart valve damage → Heart failure (endocarditis)
• Chronic pericarditis → Recurrent chest pain & inflammation
• Dilated cardiomyopathy → Chronic heart failure (myocarditis)

Preventive Measures:

• Dental hygiene & regular check-ups (reduce risk of bacterial endocarditis)
• Vaccination – Flu, pneumococcal, and COVID-19 vaccines may lower viral myocarditis risk.
• Prompt treatment of infections (strep throat, Lyme disease, tuberculosis).