bacterial endocarditis

[Kms2326]

Hi,

I am a 26 year old caucasian female...  I have been having an aray of odd symptoms starting from over a month ago, to ones that developed within the past week...  The final symptom that I noticed is dark splinter like lines running through 3 of my fingernail beds.  I take good care of my nails, (as a professional, they must always look nice), so when these lines started developing, I started doing even more research on all of my symptoms...  I found several articles stating that it is most likely a splinter hemorage.  I havent done any heavy lifting or activities out side of the norm that would cause this to occur.  I dont currently have health insurance because I just relocated from Chicago to California...  Out of the 18 symptoms listed, of that I can tell, feel and see, I have 12...  which i have listed below...-
fatigue
weakness
fever (low grade.. fluctuates between normal and very low)
chills
night sweats
muscle aches and pains (which get bad)
shortness of breath with activity (walking back from the grocery store I am not able to breathe... and I am not that badly out of shape to be that out of breath)
swelling of feet
sweating, excessive
paleness
splinter hemorrhages under 3 nails
joint pain
-I also keep having pains in my chest and through to my back and upper stomach where my rib cage meets.. (I thought that may have been my stomach ulcer flaring up again, but Im not sure...)  As well as muscle spasms...

If you could give me your opinoin on weather or not you think I should have this checked out, or if these symptoms could just be a sign of something else, I would greatlly appreciate it!  Normally I would just go to the doctor, but since I do not have insurance yet, and my GP is back in Chicago, I am really at a loss for what to do.  If you need me to explain any more details or need anymore info, please feel free to ask.
Thanks so much in advance!
Kind Regards,

[eskim0pie]

I had endocarditis last october. I had a severe migraine for five days, I couldnt even go outside without sunglasses the sun was hurting my eyes. Im so happy I went to the er over a walk in clinic. My symptoms developed quickly and they told me I would have died if I hadn't seen them that night. My blood pressure was 40/20. I was having severe night sweats. Spent 20 days on life support, 70 days in the hospital and had open heart surgery on December 5th. My surgeon put a ring in and unfortunately my valve is regurgitating so I need another surgery.

[Sam922]

thats not true, i went untreated for a month or so and didn't go to the er until a piece of vegitation broke off and traveled to my popital artery.  Depending on the person it could be flu like symptoms the first few weeks.

[cmt51597]

I'm happy to see that you have made the appointment with the clinic.  The important thing is to go somewhere at this point and have a starting point. The clinic should be drawing some blood for cultures and either testing on-site or sending it out.  It your blood does come up positive for something, then after that there's a good chance that they will send you for an echocardiogram as an out-patient either at a hospital facility (still as an out-patient) or another out-patient testing facility.  I hope your blood is clear though as you don't want endocarditis.  

Just a word of advice.....if something is nagging you for more than 3-4 days and it's not something some benadryl or Theraflu can help you with, you probably need to see a doctor, especially when you are young.  

Good luck in Cali and with your new job!  And as far as the arguing--it's just a healthy debate.  We are probably just coming in at the problem with different perspectives.  I am an echo tech and have seen what a vegetation can do to a heart valve, so it really concerns me when you have related symptoms.

[sugarpea013]

I have to side with maggiemag. I'm also in the medical field and have come across MANY PA's that were far more competant than a lot of doctors I know. An urgent care facility is a great place to start. The ONLY thing an ER is going to do is run up huge dollar tests, and in the end advise you to follow up with so and so. I understand your difficult situation with the insurance...but I would definately go in to be seen. Your health is not something to toy around with.Best wishes

[Kms2326]

Hi,

I just wanted to thank you both for the information and opinoins..  It does help to get views on both sides of the spectrum.  I dont know what is wrong with me and the pains in my chest, as well as my fatigue keep getting worse.  I have tried pretty much everything I can to make myself feel better... and nothing is working.  I start my new job here in Cali on Monday (working in the legal field..) so whatever is causing this I need to kick, ASAP.   You are right- I am a very strong person.. I just moved 2,000 miles to a city where a know no one- for a job and to finish my degree..  ;)  
I was just on the phone with my best friend (about 8 hours south of me...) who talked me into going to a clinic.  I was looking online and found that there is a free clinic for people without healthcare insurance, and am calling tomorrow for an appointment.  you can bet Ill start making donations to their organization...  
And please dont argue.. I didnt mean to cause a problem.  I was just hoping to get some info.. and I do truley appreciate it all.  Ill reply once I find out whats causing this.
Thanks so much!
Kelly

[Kms2326]

Hi,

I just wanted to thank you both for the information and opinoins..  It does help to get views on both sides of the spectrum.  I dont know what is wrong with me and the pains in my chest, as well as my fatigue keep getting worse.  I have tried pretty much everything I can to make myself feel better... and nothing is working.  I start my new job here in Cali on Monday (working in the legal field..) so whatever is causing this I need to kick, ASAP.   You are right- I am a very strong person.. I just moved 2,000 miles to a city where a know no one- for a job and to finish my degree..  ;)  
I was just on the phone with my best friend (about 8 hours south of me...) who talked me into going to a clinic.  I was looking online and found that there is a free clinic for people without healthcare insurance, and am calling tomorrow for an appointment.  you can bet Ill start making donations to their organization...  
And please dont argue.. I didnt mean to cause a problem.  I was just hoping to get some info.. and I do truley appreciate it all.  Ill reply once I find out whats causing this.
Thanks so much!
Kelly

[maggiemag]

LOL.  I guess if you can diagnose bacterial endocarditis over the internet, then her GP ought to be able to diagnose it over the phone!  After all, s/he is a physician.  Haha....just couldn't help it.

[often]

I guess I wasn't clear enough....I would not expect her GP to diagnose...but I thought that perhaps he could give her some advise that was not overly dramatic.  I am not going to get in a pissing match with you...

[cmt51597]

If it will save her life I would be more than happy to help her pay the bill.  There are few Urgent Care/Walk-in clinics with a competent echo tech and an up-to-date echo ultrasound system.  If you were a major company getting audited by the IRS would you go to joe blow accountant or one of the big 5?  There's certain facilities for certain services.  

The GP, while it would be good to talk to is not going to be able to diagnose endocarditis a thousand miles away and over the phone-- and would be wrong to without the necessary diagnostic studies performed.  You obviously don't understand endocarditis or its LIFE THREATENING effects.  

BTW-- have that one band-aid ready so you can give it to that guy that crashes out of a car window in a crash.  He's really going to need it!

[often]

While I agree we cannot put a price on our health, I am also aware of how hard it is to clear a med bill in the thousands...If you had a good relationship with your GP in Chicago, why not give him/her a call, explain to the receptionist you really need to talk to the doc, discuss your symptoms, and make your decision based on what he tells you...

If you don' t have that option....then I would suggest you start with the Urgent Care/Walk-in clinic.  Despite the horror stories above.  Perhaps CMT will offer to pay your ER bill.

[maggiemag]

Thank you for your comments.  I do realize that I tend to be a minimizer at heart, but I still think  you are an alarmist.  I am not just a lay person with an opinion, I am an RN with 37 years of experience and a master's degree with a very wide variety of experience, and  a bunch of it in  ICU.  I also have  severe cardiac issues myself and do know some stuff.  lol.    Most of her symptoms are non-specific and the first place I would urge her to go is her PCP.  Since she has none at the moment and no insurance, a walk-in clinic is a good place to START.  Surely they can hear a murmur?  Surely they can assess edema, take a temp, bp, do an EKG, take a chest x-ray?  I have had an ER physician totally miss my DCM with an EF of 15%!  They took my pulse with a pulse oximeter, and missed the BLATANT and SERIOUS ventricular arrhythmias!  ERs are not infallible and the clinic is a good place to start the investigation.  Many of the people who post here are alarmists in my opinion.  A little knowledge is not a good thing sometimes! How long have you been en echo TECH?   Self diagnosis is bad for the lay person, and leads to massive unnecessary anxiety and tons and tons of unnecessary testing, which you will see if you continue on this site.  Many of the people who post on this site have anxiety disorders, and some even admit it!  Endocarditis has declined in incidence with the decline in rheumatic heart disease.  Many who get it now are IV drug users.  People who are septic are very very sick!  You have jumped to many conclusions..........MRSA for god's sake!

I may be wrong but I have a really good track record, and you don't know me either!  I do appreciate your trying to help this person, though.

[cmt51597]

Thanks UFGators.....I don't feel like such an alertist now!  Yes Meningitis is also something not to fool around with.  PAs are great when you have bronchitis or need to alter your meds, but in these critical cases, the docs are just better trained in dealing with these cases.  Why do you think in most states there needs to be an MD overseeing the PAs?  PAs are no doubt critical to the current healthcare system--- they project there to be 100,000 of them in the U.S. by 2010 and they are critical for rural areas with a lack of docs. But, if she (the young woman in question) was my family member, I'd get her to an ER so fast she wouldn't even have a chance to blink before we arrived there.  If my story about the teacher from Connecticut is not motivation enough, I don't know what is.  Thanks again and go Gators!!  I have a pair of scrubs with the Gators emblem.  I hope your cousin is doing OK now.  

BTW-- great statement - "No one would die of heart problems in this country if everyone had overtly obvious symptoms before an event."-- really!!  And if they did all have overtly obvious symptoms then there wouldn't be enough cardiologists to see them all or enough echo techs to perform all of those echoes.  One time I did an echo on an out-patient and found severe aortic stenosis - again, no overtly obvious symptoms.  I called the cardiologist on the case and asked if I should release the patient or have him admitted.  The doc said to release him. But, later I asked him about his decision.  He said there are plenty of people walking around with severe aortic stenosis.  If the patient did drop dead on his way home, I won't say what the doctor said what we should do with the echo report (but you can guess!).  

[UFGators]

I agree...go to the ER. Money is no object when health is at stake. Most clinics have PA's and not physicians. No offense to PA's but I would rather see a doctor......my cousin almost died from meningitis when it was misdiagnosed by a nurse practitioner. Take this seriously. There is acute endocarditis and sub-acute which presents more subtly and over a longer period of time. Just because you don't have symptoms of a faulty valve, which would predispose you to this problem, does not mean you don't have a heart problem. No one would die of heart problems in this country if everyone had overtly obvious symptoms before an event. Hope this helps...don't be afraid or self-concious about going to the ER; If you think you may have an emergency, that is what they are there for.

[cmt51597]

Maggieimag...you are giving very ill advise and you sound like you don't know what you are speaking of.  Maybe her symptoms or non-specific, but combined that practically mirror the symptoms that are listed in a textbook for endocarditis.  Also, did you see that she is 26, can barely catch her breath after going to the grocery store and swelling in her ankles?  If that doesn't warrant the ER I don't know what does.  And if it's nothing, or very manageable, maybe it's more money, but are you really advising this nice young lady to risk her life over a few bucks?  That is scornful to advise that.

If she goes to a general practitioner, if he or she is prudent, they should order an echocardiogram for her- if they do not, it would be malpractice given the symptoms she describes and are confirmed.  And of course she needs blood cultures performed as well and maybe a general practitioners facility cannot do this in a timely matter, will probably have to send the blood out and may not get results for 24-48 hours- critical time she would lose if she needs the heavy antibiotics.  

She is young and probably strong, and she might be able to tolerate the endocarditis for a few weeks.  But, I don't think you read her post carefully.  She said that many of the symptoms only "developed" in the past week.  I know plenty of cases in the hospital where they probably had endocarditis for weeks before getting admitted to the hospital. I'm an echo tech-- I've seen this occur plenty of times.  Endocarditis doesn't just develop overnight.....where do you think the vegetation related to endocarditis comes from?  They can be several centimeters long--- this does not happen overnight.    Simply a walk-in clinic (unless very advanced and comprehensive) is not going to have the diagnostic capability to diagnose endocarditis, and if so, the practitioners there will likely not be experienced enough in this condition to deal with it, especially with such a young subject.  When she gets the echo done it's better that an echo tech experienced in identifying and looking for a heart valve vegetation be doing the echo-- much more likely found in a major hospital.  Even if the transthoracic echo is false for a vegetation, the docs will still want to do an transesophageal echo to rule it out and even then it's not 100% confident in making the diagnosis.  But there is a chance at her age her pictures will be clear enough transthoracically and should might not need the TEE.  In any case, the hospital/ER is where she should be headed.  

Additionally, many heart valve problems are not noticeable until they become severe.  And at her age it's very unlikely she's had a previous echo to evaluate her heart valves unless she's had a congenital heart condition.  Even so, this statement shows your lack of knowledge in this area.  Many heart valve problems can go withhout clinical symptoms for decades, and even then the patient might not connect the dots.  

I am not scaring her to death....but if she does have endocarditis...it needs to be taken care of by a facility that can do this competently and from my experience that's not an out-patient clinic.  I wouldn't trust most out-patient clinics to do an EKG on me.  You know Maggie what would be really expensive Maggie--- if we lost a promising young  life due to uninformed and inaccurate advice.  She's an adult--she's asked for advice.  I gave her the complete picture and all related information.  I think she is smart enough not to get scared and evaluate the facts.  What's more scary is when I see someone recommending a walk-in clinic for a potentially life-threatening, serious condition---that to me is very scary.  

[maggiemag]

Frankly, if you had endocarditis, especially with symptoms for a week to a month, you would be too sick to research it or post on this board, in my opinion.  Most of what you mention are non-specific symptoms and could relate to many many things.  Maybe try a walk-in clinic as it won't be as expensive as an ER and you will still be seen by a physician.  If you had no prior symptoms of a heart valve problem, it makes it even less likely.  Be careful what you read on the internet......it can scare you to death, and most of the time, unneccessarily.

[cmt51597]

You need to get yourself to the ER pronto!  You can't play around with this.  If you don't get this taken care of you won't be around to worry about health insurance.  I know it's not an ideal time, but if you just got into a traumatic car crash today and needed care in order to survive that wouldn't be convenient either.  You are still young enough where you have plenty of time to pay the money back.

That being said, it sounds like what you have is endocarditis, which is an infection of the heart, usually present on the heart valves and can be seen as a "vegetation" or growth on valves on an echocardiogram.  So, you need to get to a hospital, get on antibiotics and get and echocardiogram right away.  I am a registered echo tech and have studies endocarditis and this sounds like a typical case, especially the fatigue and night sweats.  Go to a search engine and type in "endocarditis and symptoms" and you will see that most if not all of your symptoms are present.  

Then the question becomes (if you do have this) - how do you fight this.  As I mentioned, once you get to the hospital, if endocarditis or other possible infection (called septicemia or infection of your blood- a bacterial infection) they will put you on heavy antibiotics.  I just hope that if you do have a vegetation that it has not done any damage to any of your heart valves- this is a major risk.  But, just get to an ER.  You are too young to take any chances!  

As far as how you got this-- there are many possibilities.  It could have started as something called MRSA and then got worse and worse and manifested in your current situation.  We can worry about how later on.  RIGHT NOW we need to rule out the endocarditis or septicemia and if it's positive, can it taken care of IMMEDIATELY!

Please, don't fool around with this and your life.  I once had a patient, a lady who relocated from Connecticut to Florida for teaching job.  She started out having a bad cough...was busy with the move and such and ignored it.  It turned into pnemonia, which turned severe. Within a week of moving to Florida, her respiratory system shut down and she had to be put on a respirator and in intensive care in an unconscious state.  I don't know if she survived but she was only in her mid-30s.  Sometimes when we are young we don't think things can take such a drastic turn for the worse with our health, but it can and with this condition you might have IT CAN!

It's too bad about your current situation with the insurance, but right now your life is in the balance.  That's a secondary consideration at this point.  So, get off your computer, get changed and get yourself (or better yet) get someone to take your to the nearest emergency room (a major hospital is better for this condition) ASAP!!!  Go, now!!  Let me know how it turns out.  I am close in age to you--I'm in my early 30s.  You sound smart and nice and I would hate to see anything happen to you.  If you have anymore questions, please respond....but if you do I hope it's after you've been to the hospital to get this resolved.

Cliff