Difference Between Endocarditis and Pericarditis

The heart is a complex organ which acts as two pumps stuck together. It has four chambers. Two atria open into two ventricles. The left side is separated from the right side by inter-atrial and inter-ventricular septum. The heart is lined by a thin layer of cells and connective tissue called the endocardium. Endocardium forms the valves, cordea tendinea and the innermost layer which is in contact with blood. The muscle layer is also known as the myocardium. The outermost layer is the pericardium. The pericardium has two layers. The layer covering the heart adhered to it tightly is the visceral pericardium. The layer lining the fibrous pericardial sack is the parietal pericardium. There is a potential space which contains a tiny amount of fluid to lubricate movements of the heart. Inflammation of these components present differently, and this article outlines the basic differences between endocarditis and pericarditis.

Endocarditis | clinical features, symptoms and signs, diagnosis, prognosis, and treatment methods

Endocarditis is inflammation of the innermost layer of the heart. It may be due to infections (infective endocarditis) and autoimmunity (Libmann Sacks endocarditis). Infective endocarditis may occur after soar throat, skin infections, and dental disorders. The risk is high if the patient has had rheumatic fever and valve disorders. The commonest organism is lancefield group A beta hemolytic streptococcus. Hemophillus, actinobacillus, cardiobacterium, eichinella, and Kingella are the other known causative bacteria.

Endocarditis presents with a low grade fever, chest pain, and palpitations. On examination, fever, pallor, finger clubbing, splinter hemorrhages, Janeway lesions, Oslers nodes, and new cardiac murmurs may be detected. Blood cultures should be taken at three sites, at three different times at three peaks of fever. ESR, CRP, FBC, echocardiogram, chest X-ray and ECG are other necessary investigations.  Duke’s criteria are the diagnostic tool currently used to diagnose infective endocarditis. There are two major criteria and five minor criteria. To diagnose infective endocarditis, two major criteria or one major and two minor criteria should be fulfilled. Major criteria are positive blood culture (typical organisms in two separate blood cultures, persistently positive blood culture) and significant valve abnormality (new found valvular regurgitation, calcification or vegetation on the valve leaflets). Minor criteria are blood culture that does not fall into major criteria, valve lesions that do not fall into major criteria, fever, immunological signs, and raised ESR/CRP.

Complications of infective endocarditis are septic embolization, heart failure, arrhythmias, and septicemia. Antibiotics are the mainstay of treatment.

Pericarditis | clinical features, symptoms and signs, diagnosis, prognosis, and treatment methods

Pericarditis is the inflammation of the outermost covering of the heart. Pericarditis may be due to infections, malignant infiltration, and heart failure. Patient presents with continuous central chest pain, which is relieved by bending forwards. There may be elevated jugular venous pressure, low pulse volume, muffled heart sounds. ECG may show saddle shaped ST segment elevations and low amplitude R waves. Echocardiogram may show fluid collection in the potential pericardial space.

Anti-inflammatory drugs, antibiotics, and pericardiocentesis are effective depending on the cause. Complications include arrhythmias, heart failure and pericardial effusion.

What is the difference between Endocarditis and Pericarditis?

• Endocarditis is the inflammation of the inner covering of the heart while pericarditis is inflammation of the outer covering of the heart.

• Endocarditis presents commonly with palpitation, fever of unknown origin, and chest pain. Pericarditis presents with a chest pain that lessens with bending forwards.

• Pericarditis can occur in malignancies while it is rare for endocarditis to occur due to malignant infiltration.

• Endocarditis may not show any ECG changes while pericarditis gives rise to characteristic ECG changes.

• Dental procedures, skin infections, and other septic foci can infect already abnormal heart valves easily.