Upstate cardiologist Harold Smulyan, MD, and infectious disease expert Donald Blair, MD, tell the tale of infective endocarditis in the August 2015 issue of the American Journal of the Medical Sciences. They call the nearly complete conquest of the disease “a miracle of medical progress.”
Endocarditis is an infection of the heart valves and/or the lining of the heart. It’s usually caused by bacteria. It’s not contagious.
Their paper explains that endocarditis was first reported during routine autopsies in the early 1800s, although it was several years before its bacterial cause was identified and a century before medicines were developed to fight the bacteria.
“Before the development of antibiotics, this disease was almost uniformly fatal,” Blair says. Surgery to remove infected tissue was occasionally helpful, but survival rates improved only after antibiotics were added.
The next breakthrough came in the 1970s with the development of a method of capturing ultrasound images of the beating heart.
Smulyan recalls that “echocardiography enabled us to actually look at the valves in the inside of the heart and see infections almost directly.” Doctors could confirm the bacterial infection with a blood test and, through medical imaging, know the location and severity of its damage.
This soon led to the practice of replacing damaged heart valves.
Today, patients who develop infective endocarditis receive antibiotics, often followed by valve replacement surgery.
Heart valves are susceptible to infection because they do not receive a blood supply of their own. For this reason, white blood cells and antibiotics, which fight infection, cannot reach the valves internally and must rely on the circulating blood to reach their targets.
Smulyan and Blair point out that infective endocarditis is a different disease now than when it was discovered two centuries ago. Different types of bacteria are responsible, and different types of patients are affected. Patients who develop this disease today are generally older and likely to have medical problems such as kidney disease or heart disease.
The doctors marvel at the progress made toward curing infective endocarditis. They write in their paper that although the infection can now be cured, prevention remains elusive.