What is endocarditis?
Endocarditis is an infection of the heart's valves or inner lining. It occurs when germs get into the bloodstream and settle inside the heart, often on a valve. The infection is usually caused by bacteria. In rare cases, it is caused by fungi.
This infection can damage your heart. It needs to be treated right away. If it isn't treated, endocarditis can be deadly.
What increases your risk of endocarditis?
Your risk is higher if you have a problem that affects blood flow through your heart. That's because a blood flow problem makes it more likely that bacteria or fungi will attach to heart tissue. Some other things raise your risk too, because they can let bacteria or fungi enter your bloodstream.
You have a higher risk of endocarditis if you have:
- Had endocarditis in the past.
- An implanted heart device such as a pacemaker or implantable cardioverter-defibrillator (ICD).
- A hemodialysis access or a central venous catheter.
- Abnormal or damaged heart valves or an artificial heart valve.
- A congenital heart defect.
- Injected illegal drugs using dirty needles or without cleaning the skin.
Not all heart problems put you at higher risk for endocarditis. You do not have a higher risk if you have had:
- Bypass surgery for heart disease.
- Rheumatic fever without heart valve damage.
- A heart attack without other complications.
- Mitral valve prolapse without regurgitation or unusually thickened valve leaflets.
- A coronary artery stent.
What are the symptoms?
Symptoms may appear quickly, within a few days of infection. In other cases, they may develop more slowly. The symptoms will get worse as the bacteria or fungi grow in your heart.
Symptoms may include:
- Flu-like symptoms such as fever, chills, night sweats, and fatigue. These are often the first symptoms.
- Weight loss.
- Muscle or joint pain.
- Lasting cough and shortness of breath.
- Blood under the fingernails or tiny purple and red spots under the skin.
See your doctor if you have symptoms like these that don't go away, especially if you are at risk for endocarditis.
If endocarditis isn't treated soon, it can lead to more serious problems, such as:
- Heart failure.
- An abscess in the heart.
- Heart rhythm problems.
- Heart attack or stroke.
- Infections in other organs, such as the lungs, brain, or kidneys.
How is endocarditis diagnosed?
First, your doctor will ask about your medical history and your symptoms. The doctor will also do a physical exam to check for signs of the infection. These signs include a heart murmur, an enlarged spleen, and bleeding under the nails.
Your doctor may also do tests, such as:
- Blood cultures. These tests look for bacteria in your bloodstream.
- Echocardiogram. This is done to check your heart for problems such as infected areas or heart valve defects.
- Electrocardiogram (EKG or ECG). This test checks for heart rhythm problems.
- A chest X-ray. This is to see if your heart is enlarged or if you have signs of heart failure.
- An MRI (magnetic resonance imaging) test or a CT scan. These may be done as additional tests to check your heart for problems.
How is it treated?
Endocarditis is usually treated with antibiotics. You will probably need several weeks of treatment. The antibiotics must be given long enough and at a strong enough dose to destroy all of the bacteria.
At first you will be treated in the hospital. This is so that antibiotics can be given through a vein (IV). After your fever is gone and you are stable, you may be able to continue IV antibiotics at home. A home health nurse can help you with this.
After you have been treated with IV antibiotics, your doctor may want you to take antibiotic pills. If so, take them exactly as prescribed until they are gone. If your symptoms come back, call your doctor right away. You probably will need more antibiotics if testing shows that the bacteria were not completely destroyed.
Some people who have endocarditis need surgery to repair or replace a heart valve or to prevent complications.
You may have follow-up visits for months or years to check the health of your heart.
What can you do if you are at risk for endocarditis?
Endocarditis is most dangerous for people who have:
- Had a heart valve replaced or repaired.
- Had endocarditis before.
- A congenital heart defect.
- Heart valve problems after a heart transplant.
If you have any of these heart problems, you may need to take antibiotics before you have some kinds of dental work, surgery, or medical procedures. The antibiotics lower your risk of getting endocarditis. Your doctor can give you a wallet card to carry that says you need preventive antibiotics.
It's also very important to take good care of your teeth and gums every day. Good oral care can limit the growth of mouth bacteria that could get into your bloodstream. Practice good oral hygiene by brushing and flossing your teeth daily. See a dentist twice each year.
Other Works Consulted
- Baddour LM, et al. (2015). Cardiovascular infections. In DL Mann et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 10th ed., vol. 2, pp. 1524–1547. Philadelphia: Saunders.
- Baddour LM, et al. (2015). Infective endocarditis in adults: Diagnosis, antimicrobial therapy, and management of complications: A scientific statement for healthcare professionals from the American Heart Association. Circulation, 132(15): 1435–1486. DOI: 10.1161/CIR.0000000000000296. Accessed November 24, 2015.
- Baltimore RS, et al. (2015). Infective endocarditis in childhood: 2015 update: A scientific statement from the American Heart Association. Circulation, 132(15): 1487–1515. DOI: 10.1161/CIR.0000000000000298. Accessed November 24, 2015.
- Endocarditis prophylaxis for dental procedures (2012). Medical Letter on Drugs and Therapeutics, 54(1339): 74. [Erratum in Medical Letter on Drugs and Therapeutics, 54(1401): 84].
- Haldar SM, O'Gara PT (2011). Infective endocarditis. In V Fuster et al., eds., Hurst's the Heart, 13th ed., vol. 2, pp. 1940–1969. New York: McGraw-Hill.
- Li JS, et al. (2007). Infective endocarditis. In EJ Topol et al., eds., Textbook of Cardiovascular Medicine, 8th ed., pp. 402–419. Philadelphia: Lippincott Williams and Wilkins.
- Nishimura RA, et al. (2014). 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, published online March 3, 2014. DOI: 10.1161/CIR.0000000000000031. Accessed May 1, 2014.
- Wilson W, et al. (2007). Prevention of endocarditis. Guidelines from the American Heart Association. A guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. Published online April 19, 2007 (doi:10.1161/circulationaha.106.183095).
Current as of: August 31, 2020
Author: Healthwise Staff
Rakesh K. Pai MD, FACC - Cardiology, Electrophysiology
E. Gregory Thompson MD - Internal Medicine
Martin J. Gabica MD - Family Medicine
Adam Husney MD - Family Medicine
Elizabeth T. Russo MD - Internal Medicine
Robert A. Kloner MD, PhD - Cardiology
Current as of: August 31, 2020