Endocarditis in Women: Different Risks and Ways to Address them

By Dr. Siddhrajsinh D Vala, Consultant Interventional Cardiologist and Director of Department of Cardiology, HCG Hospitals, Bhavnagar

Women’s health,involving overall physical, mental, and emotional health is the most critical aspect of their wellbeing throughout different stages of life. The distinctive physiological and hormonal changes women experience, from menstruation and pregnancy to menopause, significantly influence their health needs and risks. These health factors impact women’s longevity and their quality of life, career, relationships, and ability to participate fully in society. While these are widely known health conditions,that we are aware of, women also are vulnerable to various health issues that we are less aware about.

Endocarditis is one such infection thatoccurs in the inner lining of the heart chambers and valves, also known as the endocardium. While this condition is not unique to women, recent studies indicate that women face critical risks and challenges related to endocarditis. Understanding these differences is crucial for improving diagnosis, treatment, and prevention among women.

Knowing about Endocarditis

Endocarditis normally occurs when bacteria or other pathogens enter the bloodstream and attach to damaged areas of the heart. Severe complications, including heart failure, stroke, and organ damage can occur due to this. The condition is more frequent in individuals with preexisting heart conditions, artificial heart valves, or a history of intravenous drug use.

What are the Unique RisksPosed to women?

• Underdiagnosis and delayed treatment: One of the key challenges to diagnosing endocarditis in women is that they are often present with atypical symptoms compared to men. While men exhibit symptoms like fever, heart murmur, and positive blood cultures, women may experience more subtle signs such as fatigue, weight loss, or generalized malaise. This may lead to misdiagnosiswhich can delay the treatment procedure.
• Hormonal influences and differences in heart anatomy: The heart anatomy and hormonal fluctuationscan influence the progression and presentation of endocarditis. For instance, hormonal changes during pregnancy can increase the risk of developing endocarditis, particularly in women with preexisting heart conditions.
• Impact of autoimmune diseases: Lupus and rheumatoid arthritis are among the autoimmune diseases that affect women more than men. These can increase the risk of endocarditis because they often involve inflammation of the heart valves.

How do we address these risks?

It is very important to address the risk factor that leads to more women living with endocarditis without receiving a timely diagnosis.

• Awareness and education: It is essential to raise awareness among healthcare professionals regarding the unique presentation of endocarditis in women. This may include understanding the subtle symptoms that differ from the ones witnessed by men. Educating women regarding the risks and those with heart conditions or autoimmune diseases can result in better timely diagnosis.
• Regular screenings: Women with a history of heart disease, autoimmune disorders, or those with prosthetic heart valves should undergo regular screening for endocarditis, especially if they experience unexplained symptoms like fatigue or weight loss.
• Preventive Measures: Women at high risk for endocarditis should be proactive in preventing infections that could lead to the disease. This includes maintaining good oral hygiene, as dental procedures can introduce bacteria into the bloodstream, and avoiding intravenous drug use.

The Way Forward

Endocarditis is a serious disease that requires prompt diagnosis and treatment and for women the risks and challenges associated are distinct. By raising awareness, improving screening, and addressing gender biases, we can better protect women from the dangers of endocarditis and improve their overall heart health.