Non-infective endocarditis

Non-infective endocarditis is a condition characterized by the inflammation of the inner layer of the heart, the endocardium, without the presence of an infection. This condition can affect the heart valves, leading to their dysfunction. Non-infective endocarditis is also known as nonbacterial thrombotic endocarditis (NBTE) or marantic endocarditis and is often associated with systemic conditions such as cancer, autoimmune diseases, or hypercoagulable states.

Causes and Risk Factors

Non-infective endocarditis is typically associated with a variety of systemic conditions. Key causes and risk factors include:

• Cancer, particularly mucinous adenocarcinomas which can lead to a hypercoagulable state, increasing the risk of thrombus formation on the heart valves.
• Autoimmune diseases such as Systemic Lupus Erythematosus (SLE), which can cause inflammation and damage to the heart valves.
• Hypercoagulable states, either inherited or acquired, which increase the risk of thrombus formation.
• Severe medical conditions that lead to a cachectic state, where the body is weakened and more susceptible to the development of non-infective endocarditis.

Symptoms

Symptoms of non-infective endocarditis can vary widely depending on the extent of the valve damage and may include:

• Heart murmurs, which are often the first sign detected during a physical examination.
• Symptoms of heart failure, such as shortness of breath, fatigue, and swelling of the legs and feet, due to the heart's reduced ability to pump blood effectively.
• Embolic phenomena, where parts of the thrombus break off and travel to other parts of the body, potentially causing organ damage.

Diagnosis

Diagnosis of non-infective endocarditis involves a combination of clinical assessment, imaging, and laboratory tests:

• Echocardiography is the primary imaging modality used to visualize the heart valves and detect the presence of vegetations or thrombi.
• Blood tests to rule out an infectious cause of endocarditis, as well as to assess for underlying conditions that may contribute to the development of the disease.
• Clinical history and physical examination to identify symptoms and risk factors associated with non-infective endocarditis.

Treatment

Treatment of non-infective endocarditis focuses on managing the underlying condition and preventing embolic complications:

• Anticoagulation therapy may be used to reduce the risk of thrombus formation and embolic events.
• Treatment of the underlying systemic condition, such as chemotherapy for cancer or immunosuppressive therapy for autoimmune diseases.
• In severe cases, surgical intervention may be necessary to repair or replace damaged heart valves.

Prognosis

The prognosis of non-infective endocarditis depends on the underlying cause and the presence of complications. Early detection and management of the condition and its associated systemic diseases are crucial for improving outcomes.