The causes of endocarditis may be:
- Infectious as bacterial endocarditis by e.g.:
- Staphylococci in approx. 45 - 65 %.
- Streptococci in approx. 30 %
- Enterococci < 10 % ( Herold 2022 / Kasper 2015)
- pneumococci
- Rare pathogens are e.g. Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Coxiella burnetii, Chlamydia, Eikenella corrodens, Kingella Kingae, Mycoplasma, Legionella, pathogens of the HACEK-group
- Fungi (approx. 1 %) (Herold 2022)
The main entry sites are the oral cavity, skin and upper respiratory tract (Kasper 2015).
- Abacterial form:
This form is also known as non-infectious endocarditis.
It can occur as:
- E. rheumatica (verrucosa), a disease caused by beta-hemolytic streptococci, which can occur as a complication of rheumatic fever (Herold 2022).
- E. Libman- sacks, which is caused by systemic lupus erythematosus (SLE) (Herold 2022).
- Endomyocarditis eosinophilica, also known as "Löffler- syndrome", which can occur in the context of various diseases and is always associated with an increase in eosinophilic granulocytes (Herold 2022).
- Mixed form:
In this case, additional bacterial inflammation occurs on the floor of abacterial endocarditis (Herold 2022).
- Pharmaceutical-induced valvular changes:
These can be caused by, for example, Parkinson's drugs with dopamine agonistic effects such as cabergoline, pergolide. They lead to fibrotic heart valve damage. Similarly, ecstasy (MDMA) can cause changes in heart valves (Herold 2022).
- Endocardial fibroelastosis (EFE).
The exact cause has not yet been determined with certainty. Studies suggest that it is not an idiopathic event, but likely has a genetic component, probably x- chromosomal recessive (Sana 2022).
Other studies suggest a possible association with autoimmune processes, as maternal anti-La and anti-Ro antibodies are often detectable (Sana 2022).
EFE can occur alone, but is combined with other genetic disorders such as aortic stenosis, atresia, hypoplastic left heart syndrome in 20-50% of cases (Sana 2022).