ST. LOUIS, Oct. 7 – Mike Martz, coach of the St. Louis Rams football team, missed two practices this week because of what his doctors think may be infective endocarditis. He may not be stalking the sidelines when the Rams play the Seattle Seahawks on Sunday.
The team’s physician, Douglas Pogue, M.D., is still conducting tests on the 54-year-old Martz, who told reporters earlier this week that he has been feeling ill for several weeks.
Action Points
- Advise patients who ask that endocarditis most typically occurs in patients with underlying valvular disease.
- Advise patients that antibiotic treatment for endocarditis is usually effective, but mortality varies according to the pathogen involved and the circumstances of the condition.
“There is some type of infection in my body that has gotten worse," Martz told reporters, but Dr. Pogue said later in a statement that the diagnosis of endocarditis hasn’t been confirmed yet.
Endocarditis affects between 10,000 and 15,000 people every year in the U.S., said Roger Blumenthal, M.D., director of the Johns Hopkins Ciccarone Preventive Cardiology Center in Baltimore.
“Generally, people who get endocarditis have some sort of abnormality in their heart valve to begin with,†Dr. Blumenthal said. “The normal heart is much less likely to run into problems.â€Â
The American Heart Association says that people at risk for the disease include those with:
- A prosthetic heart valve
- A history of previous endocarditis
- Valves damaged by conditions such as rheumatic fever
- Congenital defects in the heart or valves
- Or hypertrophic cardiomyopathy
Endocarditis – formally an infection of the heart lining or valves – often arises from bacteremia after surgery, whether major or minor. Gum surgery, for instance, is often the spark that gives rise to the condition. Other risk factors are intravenous drug use, permanent central venous access lines, prior valve surgery, and weakened valves.
Bacteria, such as Staphylococcus aureus, colonize the tissue and form masses known as vegetations at the infection site. Under a microscope, the pathogen can be seen embedded in a mesh of fibrin and other materials.
In rare cases, endocarditis can be caused by a fungal infection.
Mortality varies depending on the pathogen involved, according to the Merck Manual of Diagnosis and Therapy, ranging from less than 10% for Viridans streptococcus infection without major complications to nearly 100% with Aspergillus infection after prosthetic valve surgery.
The condition can be chronic, but is generally acute, Dr. Blumenthal said.
The diagnosis of infective endocarditis is made on the basis of a careful history and physical examination, blood culture and laboratory results, an electrocardiogram (ECG), a chest radiograph, and an echocardiogram. Criteria for diagnosis include positive blood cultures in the absence of an obvious focus and the presence of cardiac involvement as shown by echocardiogram or the development of new valvular regurgitation. Testing for the condition – such as Martz is undergoing – generally includes:
- Baseline studies, such as complete blood count (CBC), electrolytes, creatinine, blood urea nitrogen (BUN), glucose, and coagulation panel.
- Blood cultures, to try to identify a pathogen.
- Transthoracic and transesophageal echocardiography, both highly specific for valvular vegetations. Echocardiography is particularly indicated if the cultures are negative, as would be the case if the condition is caused by a fungal infection.
Martz said his main symptom is fatigue. “You feel really good and then in the course of a couple hours you hit rock bottom,'' he said in the statement.
Dr. Blumenthal said other possible symptoms include persistent fever and chills and unexplained weight loss.
In the case of an otherwise healthy adult like Martz, Dr. Blumenthal said, antibiotic treatment is usually effective. “I would be more worried for people who have an immune suppression for one reason or another,†he said. That would include patients with HIV, hepatitis C, or cancer, he said.
“This is something that if you let it go, it could become a real issue,†Martz said, noting that he did not plan to attend any of the team’s practices this week before Sunday’s game with the Seattle Seahawks.
Whether he will be on the sidelines for that game hasn’t been decided yet, Jay Zygmunt, the Rams’ president of football operations told the St. Louis Post-Dispatch earlier this week.
“That'll be addressed when we have to address it,†Zygmunt said.