Endocarditis and Myocarditis

Endocarditis^1 2 

• Infective endocarditis (IE) is a life-threatening infection and inflammation of a heart valve or the inner lining of the heart’s chambers and valves (endocardium) causes endothelial damage.
• Platelets and fibrin deposited at sites of damage become a substrate for bacterial adherence.
• Caused by an infection (bacteria fungi, other) that may damage or destroy heart valves.
  • Improper dental care
  • Catheters
  • Illegal IV drug use
• Signs and symptoms: Chills, fever, headaches, joint pain, shortness of breath.
• Risk factors: older age, artificial heart valves, damaged heart valves, congenital heart defects, implanted heart device, history of endocarditis, history of IV drug use, poor dental health, and long-term catheter use.
• Complications: myocardial dysfunction, embolization (pulmonary embolism), congestive heart failure, CVA, abscesses in organs, kidney damage, enlarged spleen.
• Treatment: depends on the underlying cause
  • Medications
  • Surgery: heart valve repair or replacement (artificial prosthetic, animal, human)
  • DVT/PE prophylaxis
• Occupational therapy: therapy for persisting physical symptoms, diminished QoL, and difficulties returning to work up to 1 year post discharge.^3 4 
  • Precautions: risk of bleeding at the surgical site
  • Individualized treatment – inpatient or outpatient
  • Patient education of disease, symptoms, and healthy lifestyle
  • Addressing deconditioning and fatigue with occupations and exercise training
  • Improve QoL
  • Provide psychological support
  • Outcome measures: 6-minute walk test, Sit to stand test

Myocarditis^5 6 

• Inflammation and infection of the myocardium (heart muscle) which reduces the heart’s ability to pump or have a normal heart rhythm (cardiac dysfunction).
• May be asymptomatic or have different clinical presentations.
• Causes: infection, often viral but may be bacterial, parasitic, or fungal; reaction to a drug (including illegal substances such as cocaine); a general inflammatory condition (exposure to chemicals, radiation); or due to other disorders such as lupus.
• Signs and symptoms: angina, fatigue, shortness of breath, arrhythmias, edema
  • S/S of viral infection: headache, body aches, joint pain, fever, sore throat, diarrhea (mimics a heart attack)
• Complications: heart failure, MI, CVA, arrhythmias, cardiac arrest may be fatal
• Prevention: avoiding people who have viral/flu, following good hygiene, avoiding risky behaviors such as unsafe sex or illegal drugs, minimizing exposure to ticks, and getting vaccinated.

1. Kiefer, T. L., & Bashore, T. M. (2012). Infective endocarditis: a comprehensive overview. Reviews in cardiovascular medicine, 13(2-3), 105-120.[↩]
2. Mayo Clinic. (n.d.). Endocarditis. Retrieved from https://www.mayoclinic.org/diseases-conditions/endocarditis[↩]
3. Rasmussen, T. B., Zwisler, A. D., Sibilitz, K. L., Risom, S. S., Bundgaard, H., Gluud, C., … & CopenHeartIE Group. (2012). A randomised clinical trial of comprehensive cardiac rehabilitation versus usual care for patients treated for infective endocarditis—the CopenHeartIE trial protocol. BMJ open, 2(6), e001929.[↩]
4. Butchart, E. G., Gohlke-Bärwolf, C., Antunes, M. J., Tornos, P., De Caterina, R., Cormier, B., … & Vahanian, A. (2005). Recommendations for the management of patients after heart valve surgery. European heart journal, 26(22), 2463-2471.[↩]
5. Caforio, A.L.P., Malipiero, G., Marcolongo, R. et al. Myocarditis: A Clinical Overview. Curr Cardiol Rep 19, 63 (2017). https://doi.org/10.1007/s11886-017-0870-x[↩]
6. Mayo Clinic. (n.d.). Myocarditis. Retrieved from https://www.mayoclinic.org/diseases-conditions/myocarditis[↩]