How to diagnose rheumatic endocarditis?

The diagnosis of endocarditis requires similar examinations as in the case of acute articular rheumatism, and the results are also very similar, except in the case of endocarditis they are much more severe.

A definitive diagnosis can be made via an objective examination which will involve investigating for auscultative symptoms, which are the only symptoms which can belie potential damage of the endocardium.

Usually the first sound at the apex is weakened, the second tone in the pulmonary artery remains clear or becomes enhanced. A weakening of the sounds is a consequence of the edematous infiltration of the valves, which is why they are audible at the onset of the condition, but when the valves later on become fibrous, the sounds become louder and more dry.

If under the effect of therapy the valve process heals, the sounds will become normal once again, but if the valves begin scarring over abnormal heart sounds will become audible. A phonography is usually involved in order to be able to hear heart sounds.  

A physician will run a differential diagnosis against endocarditis with the following conditions:

  1. Acute rheumatic myocarditis
  2. Acute bacterial endocarditis. They are characterized by simultaneous septicopyemia, high fever, shivers, septic embolisms and multiple microabscesses in different organs. This is the reason why heart sounds will change for this condition from day to day.  
  3. Subacute bacterial endocarditis. People who suffer from this condition usually have preexisting rheumatoid defects over which a secondary infection is superposed. The secondary infection is most likely originated from focal infections, which occur when surgical interventions occur without the preventative use of antibiotics. Laboratory data and clinical evidence aid in concluding a differential diagnosis.  

Medically Reviewed by a doctor on 28 Mar 2018
Medical Author: Dr. med. Diana Hysi