Endocarditis, myocarditis, pericarditis

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Endocarditis

Like the name suggests, endocarditis refers to a condition where there is inflammation in the endocardium, the inner most layer of the heart wall, heart valves and chambers.

There are two main forms, infectious and non-infectious, the latter of the two being much rarer, in which the vegetations (growths made up of fibrin, platelets) found in the endocardium, are called sterile vegetations.

The most common cause is an infection, often bacterial, that leads to the formation of vegetations composed of thrombotic debris and organisms, that can damage underlying heart tissue. Aorta, aneurysmal sacs, other blood vessels and prosthetic devices may also get infected. It can develop on previously normal valves, but some conditions such as rheumatic heart disease, mitral valve prolapse etc can incline towards it. Infective endocarditis is then subdivided into acute and subacute, although most of the time cases fall between these two:

• Acute IE - progresses rapidly, starting with high fever and fast heart rate. Its associated with substantial morbidity and can quickly become life threatening.
• Subacute IE - infections that gradually develop, most patients recovering after antibiotics.

Endocarditis

Non-infective endocarditis typically doesn't have its own symptoms, rather only of the underlying disease that causes it, for example lupus, or other conditions associated with hypercoagulable states. Infective endocarditis has symptoms such as chest pain, heart murmur, tachycardia, fever, dyspnea, hematuria etc.

It is diagnosed by imaging such as MRI, echocardiogram to show the vegetations and heart damage. Bacterial cultures should be taken for infective endocarditis. Its typically treated with antibiotics, but if the damage to the heart tissue is very extensive, surgery might also be needed.

Myocarditis

Myocarditis is inflammation of the myocardium.

There are two main causes of myocarditis. Firstly, it can be a virus such as influenza, HIV, and more commonly, human herpesvirus 6. It is either the virus directly causes cell damage, or the immune response in reaction to them cross-reacts with myocardial proteins. Secondly it can be due to autoimmune conditions such as lupus. Side effects of some medications can also be a cause.

The clinical manifestations of this disease are broad, on one hand patients can be asymptomatic and recover or it can progress to the point of heart failure or even death. Symptoms in the midline include chest pain, dyspnea, fatigue, palpitations, and fever. (It can mimic those of myocardial infarction).

Typically medication is given if it does not get resolved on its own. If it leads to an abnormal heart rhythm, a pacemaker might need to be implanted.

Pericarditis

Pericarditis is inflammation of the pericardium.

Primary pericarditis is typically due to infections, most commonly viral but this is not very common. Secondary pericarditis is more common and can be caused by acute MI or development of antibodies against the myocardium, pneumonia, pleuritis, uremia.

Further classifications can be based upon the duration of the disease: acute lasting less than 4-6 weeks, subacute lasting less than 3 months and chronic lasting for more than 3 months after the initial attack. If chronic pericarditis is very extreme to the point where the fibrotic scars in the pericardium are so dense that the heart cannot expand normally during diastole, then that is called constructive pericarditis.

The most defining symptom is a sharp chest pain that worsens with coughing, swallowing or breathing deeply. If the disease is associated with significant fluid accumulation, it can also result in cardiac tamponade. Other symptoms include fatigue, fever, trouble breathing when lying down.

It is diagnosed with imaging methods and treated with medicine according to the cause, like antibiotics or anti-inflammatory medication and pain relievers.