By Tina Hesman
ST. LOUIS POST-DISPATCH
10/12/2005


A teeth cleaning ...

A stuck popcorn hull ...

Even the most innocent circumstances can lead to ...

endocarditis

Mike Martz is one of the 10,000 to 20,000 people each year who contract the heart infection.

A cold sweat gripped David Batts, 45, of Waterloo, as he sat at his desk in an architectural firm in St. Louis Hills.

Batts' temperature that day at the end of July could well have been a weather forecast - 103.8 degrees. Batts went home thinking he had the flu.

"My wife grabbed me and said, 'You're going to the doctor,'" Batts said.

But his fever and chills weren't the flu. They were symptoms of endocarditis, an infection that strikes the lining and valves of the heart.

Rams coach Mike Martz has been struggling for six weeks with an acute bacterial infection that appears to be endocarditis.

About 10,000 to 20,000 people each year contract the heart infection, said Dr. Arthur Labovitz, the chief of cardiology at St. Louis University and president of the St. Louis Division of the American Heart Association. Most people who get endocarditis already have problems with their heart valves, Labovitz said.

The condition can start under even the most innocent circumstances - a routine teeth cleaning, a skin infection, getting an infection from a popcorn hull stuck in the gums - but can have deadly consequences. Bacteria enter the bloodstream and settle in the heart, growing on the valves and damaging them. Symptoms usually appear about two to four weeks after an infection starts, and may progress rapidly.

Batts doesn't know how he contracted the staphylococcus infection that invaded his heart. The source of Martz's infection is also unknown. The coach had a dental appointment in late August and complained of a sinus infection in early September. Martz fell ill about the time of the Rams' season opener in San Francisco on Sept. 11 and missed practice on Sept. 30. He announced Monday that he would take six weeks off to treat the infection.

The long treatment is standard for endocarditis, Labovitz said. Patients typically require about four to six weeks of intravenous antibiotic therapy to clear the infection.

"Endocarditis is a serious disease, make no mistake about it. It's not like getting your finger cut," Labovitz said.

In the most extreme cases, weakened heart valves may leak and cause heart failure. About 16 to 27 percent of people with endocarditis die of the disease. Between one-third and one-half of endocarditis patients may require surgery to repair or replace damaged heart valves, said Dr. Jennifer Lawton, a heart surgeon at Barnes-Jewish Hospital and Washington University.

And endocarditis carries other risks as well. Bacteria grow on the valves in structures called vegetation.

"The problem with the vegetation is that those things can break off and go anywhere in the body," Lawton said.

The dislodged bacteria can cause strokes, interfere with vision when they lodge in the eye, or cause spots and pain in other parts of the body.

For Batts, a black spot that appeared on the ring finger of his right hand a week after he went to the hospital was the telltale sign that tipped doctors off to his endocarditis. Before then, they thought he had meningitis, he said.

Endocarditis can be hard to diagnose, Lawton said. Early symptoms resemble the flu - fatigue, achiness, fever and chills - and patients may not seek medical help immediately. When heart valves are seriously affected, patients become short of breath and may have chest discomfort. Those symptoms often send people to the doctor, but even then may be confused for other conditions.

Doctors take blood cultures to identify the bacteria causing the infection, but sometimes the bacteria don't grow well in the laboratory. Echocardiograms - ultrasounds of the heart - may show vegetation on the heart valves and detect leaking. But sometimes the images of the heart are not clear enough to diagnose the problem and doctors must use a more complicated method, called a transesophagael echocardiogram. In that procedure, doctors snake a tube down the patient's throat and view the heart from the esophagus using ultrasound waves.

People who have had endocarditis are at higher risk of contracting the disease again, Lawton said.

Batts isn't taking any chances of developing the heart infection again.

"I'm not eating popcorn anymore. I shave with an electric razor now. Anything to keep from bleeding. That fear will subside eventually," Batts said, "but right now I'm scared to death."

Causes of endocarditis

The bacteria that cause endocarditis can enter the bloodstream in a variety of ways. Here are some medical and dental procedures that may require preventive antibiotics to stave off infection in people prone to getting endocarditis.

Removal of tonsils or adenoids

Prostate surgery

Surgery on the intestines or bile ducts (including gall bladder surgery)

Heart or lung surgery

Insertion of catheters or intravenous lines

Scoping the nasal passages

Root canal

Anesthetic injection into ligaments

Cleaning or pulling teeth

Putting orthodontic bands beneath the gums

Replacing teeth that were knocked out

Dental implant placement