Endocarditis

Topic Overview

What is endocarditis?

Endocarditis is an infection of the heart's valves or its inner lining (endocardium). It is most common in people who have a damaged, diseased, or artificial heart valve.

See a picture of endocarditis .

What causes endocarditis?

Endocarditis is caused by bacteria (or rarely, fungi) that enter the bloodstream and settle on the inside of the heart, usually on the heart valves. Bacteria can invade your bloodstream in many ways, including during some dental and surgical procedures. If you don't take care of your teeth, having your teeth cleaned or even brushing your teeth can cause bacteria to enter the bloodstream.

What increases the risk for endocarditis?

If you have a normal heart, you have a low risk for developing endocarditis. But if you have a problem with your heart that affects normal blood flow, it is more likely that bacteria or fungi will attach to heart tissue. This puts you at a high risk for endocarditis.

If you have certain heart conditions, getting endocarditis is even more dangerous for you. These heart conditions include:

• Artificial heart valves.
• Endocarditis in the past.
• Heart defects since birth (congenital heart defects).
• Heart valve problems after a heart transplant.

Other risk factors that put you at risk for getting endocarditis include:

• Having hypertrophic cardiomyopathy.
• Having hemodialysis, which is a treatment to clean the blood, for people with kidney failure.
• Injecting street drugs using dirty needles or without cleaning the skin.
• Having AIDS. Acquired immunodeficiency syndrome reduces your ability to fight infection.

What can you do if you are at risk for endocarditis?

Some heart problems can put you at risk for endocarditis. These heart conditions include:

• Artificial heart valves.
• Endocarditis in the past.
• Heart defects since birth (congenital heart defects).
• Heart valve problems after a heart transplant.

If you have any of these heart conditions, you may need to take antibiotics before you have certain dental and surgical procedures. The antibiotics lower your risk of getting endocarditis. These procedures include:

• Certain dental work or dental surgery.
• Lung surgery.
• Surgery on infected skin, bone, or muscle tissue.
• Certain medical procedures, such as a biopsy.

Maintaining good oral hygiene is especially important to prevent endocarditis if you are at risk.

Your doctor can give you a card to carry in your wallet that states that you need preventive antibiotics before certain procedures.

What are the symptoms?

The symptoms of endocarditis progress as the bacteria or fungi grow in your heart. Vague, flu-like symptoms, such as a low-grade fever and fatigue, often occur first. Most people with endocarditis begin to have symptoms within 2 weeks after becoming infected with bacteria or fungi.

But a powerful strain of bacteria may cause symptoms to appear much faster, within a few days.

Symptoms include:

• Chills and fever.
• Fatigue.
• Weight loss.
• Night sweats.
• Painful joints.
• Persistent cough and shortness of breath.
• Bleeding under the fingernails.
• Tiny purple and red spots under the skin, called petechiae.

Although symptoms are vague and may not seem worth telling your doctor about, if they don't go away or if you know you are at risk for endocarditis, contact your doctor.

If endocarditis is not treated, the bacteria that cause endocarditis can form growths on or around the heart valves. The growths prevent the heart valves from opening and closing properly. This interrupts the normal blood flow through the valves and interferes with the heart's pumping action. Blood can leak backwards instead of being pumped forward. Over time, heart failure can develop because your heart may not be able to pump enough blood to meet your body's needs.

Endocarditis can also cause other problems, including:

• Abnormal heartbeat.
• Stroke.
• Kidney failure.

How is endocarditis diagnosed?

First, your doctor will ask about your medical history and do a physical exam. If your doctor thinks that you may have endocarditis, he or she will check for signs of the infection, such as a heart murmur, an enlarged spleen, skin rashes, and bleeding under your nails.

Blood cultures will be done to check for bacteria in your bloodstream, and other tests, such as an echocardiogram, may be done to check your heart function and look at your heart valves.

It is important to treat endocarditis as soon as possible to avoid permanent damage to the heart muscle or heart valves.

How is it treated?

Antibiotics given through a vein (intravenously, or by IV) are the usual treatment for endocarditis. If your heart valves are damaged by the infection or if you have an artificial heart valve, surgery to repair or replace the valve may be needed. You may also need surgery if your endocarditis is caused by a fungus. If it is not treated, endocarditis can be fatal.

Frequently Asked Questions

Learning about endocarditis:	What is endocarditis? What causes endocarditis? What are the symptoms of endocarditis? What is my risk for developing endocarditis? What are the complications of endocarditis?
Being diagnosed:	How is endocarditis diagnosed?
Getting treatment:	What treatment will I need for endocarditis?
Ongoing concerns:	How can I prevent endocarditis if I have a heart problem? What should I know about antibiotics for heart problems?
Living with endocarditis:	What kind of home treatment will I need?

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Author:	Robin Parks, MS	Last Updated: April 25, 2007
Medical Review:	Caroline S. Rhoads, MD - Internal Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
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