Heart infections: how to avoid a delayed diagnosis and stay safe this winter

Posted: 05/12/2022

A growing body of research suggests that heart health is impacted by cold weather. Studies also show that the prognosis for those with heart infections falls as the air temperature drops. As we slip into the winter months, this article is intended to help individuals gain knowledge about heart infections, so that they can achieve an earlier diagnosis and better protect themselves from long term damage.

For heart infections, it is vital that a diagnosis is made as quickly as possible. They can spread rapidly and cause damage to many different areas of the body and, in some cases, where a diagnosis is significantly delayed, prove fatal. However, if investigations are undertaken in good time and the infection is picked up early, they can resolve with minimal long-term consequences.

There are three main types of heart infection, all of which have debilitating symptoms:

• endocarditis (most common) - life-threatening inflammation of the inner lining of the heart's chambers and valves;
• myocarditis – life-threatening inflammation of the heart muscle; and
• pericarditis - life-threatening inflammation of the outer membrane or sac covering the heart’s surface.

All of the above conditions result from infections that have travelled to the heart. While there are a number of different symptoms a patient with a heart infection might experience, there are some ‘textbook’ symptoms to look out for. If a patient attends A&E or their GP with the following symptoms, they should prompt further investigation:

• aching joints and muscles;
• chest pain upon breathing;
• fatigue and muscle weakness;
• flu-like symptoms, such as extreme fever and chills;
• shortness of breath;
• swelling in the hands, legs, ankles and feet;
• an increased heart rate and/or palpitations; and
• (in the case of endocarditis), a new whooshing sound in the heart (murmur).

Diagnosing heart infections in a patient with a complex or incomplete history can be difficult. However, if a patient provides a full history of symptoms and the proper tests are performed, this significantly increases the chances of an early diagnosis. It is therefore vitally important that if you are experiencing most or all of the above symptoms, you carefully explain each of your symptoms to the receptionist, doctor or nurse noting down your history, so that the right tests can be arranged.

If a patient’s symptoms give cause to suspect a heart infection, this diagnosis must be ruled out or confirmed through the following investigations:

• blood tests – which show the levels of inflammatory markers in your blood;
• a chest X-ray – which shows changes to the shape and size of the heart, as well as swelling or excess fluid;
• a CT scan or MRI scan – which can show inflammation, thickening or other changes to the heart;
• echocardiogram (echo) – which can show signs of damage to the heart;
• electrocardiogram (ECG) – which can show an abnormal heart rhythm; and
• cardiac catheterization/heart biopsy – which involves taking a small sample of heart muscle tissue to look for infection or inflammation.

Unfortunately, a delayed or incorrect diagnosis is not uncommon. Sometimes, this will be through no fault of the treating doctor. This is because less serious conditions cause similar signs and symptoms. If providing appropriate care, a health care professional should take a full history from the patient and undertake a proper evaluation of their symptoms. If this process, conducted adequately, fails to indicate a heart infection, they will be justified in coming to a different diagnosis.

However, there are occasions where a proper evaluation of the patient’s signs and symptoms does not occur. Symptoms may be missed or overlooked. At other times, all symptoms are noted, but there is a failure to appreciate their gravity. In either case, it is likely this will lead to a negligent failure to carry out the proper tests at the proper time, and therefore a delayed or incorrect diagnosis.

Once a heart infection is diagnosed, the treatment options vary depending on the nature and severity of the infection. They can involve conservative treatment (ie avoiding surgery) with medication to stop the infection and reduce the inflammation or may involve heart surgery. The type of surgery depends on the type of infection, but may involve replacing the heart’s mitral valve, draining fluid from the heart’s lining or even, in severe cases, a heart transplant. In any case of heart infection, recovery will be a long process. Of course, the sooner treatment is provided, the quicker the patient will recover and the less likely there is to be any lasting damage.

Fortunately, many patients make a full recovery. However, even where the infection does not prove fatal and the patient recovers, there is the possibility for complications to cause long term damage, particularly where treatment was not provided promptly. These complications can include:

• blood clots in the lung (pulmonary embolism);
• heart attack or stroke;
• heart failure;
• kidney failure;
• rapid heart rhythms (arrhythmias);
• intracranial (mycotic) aneurysms; and
• bacterial brain abscess.

It is therefore important that medical professionals act quickly to diagnose and treat heart infections.

Heart infections are relatively rare and, often, there is no obvious cause. However, there are some known risk factors which you (and your doctor) should be aware of:

• poor dental hygiene – where gums bleed and bacteria can enter the blood stream;
• catheters – which allow bacteria to enter your body through the tube inserted into the urethra;
• IV drug use – which allows bacteria to enter the blood stream via the needle;
• age - above 65 years of age, your body is less able to fight infection;
• previous heart surgery – as there may be existing damage to the heart;
• (in the case of myocarditis and pericarditis), bacterial, viral (most common), fungal or parasitic infections – which can spread to the heart; and
• (in the case of myocarditis and pericarditis), autoimmune diseases – which result in a suppressed immune system.

Sadly, there will be people who have suffered from a heart infection that went undiagnosed for an unacceptable length of time, either because their symptoms were negligently confused with other, less serious conditions, or their symptoms were not taken seriously at all, such that no or improper investigations were undertaken.  

Rosa Shand, an associate within the clinical negligence team at Penningtons Manches Cooper, comments: “It is vital that health care professionals providing ‘first line’ care to patients look out for the signs and symptoms of a heart infection and promptly arrange further investigations. In many cases, had the patient’s symptoms been properly assessed on their initial interaction with the health care professional, they would have been referred for urgent blood tests, which would have revealed high inflammatory markers and resulted in their admission to hospital for further testing and treatment. Sadly, in some cases, by the time diagnosis is made, the infection has caused irreparable damage to the heart and other organs in the body, including the brain.”

The team at Penningtons Manches Cooper can help those who have experienced delayed diagnosis of a heart infection achieve compensation for the pain and suffering they experienced and the long-term injuries they have sustained as a result. If you, or anyone you know, has been injured as a result of a heart infection and you suspect it could have been diagnosed earlier, please contact us to find out if we can help. Initial advice is offered free of charge and without obligation.

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