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.
What causes endocarditis?
Endocarditis is caused by bacteria (or in rare cases, by 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 endocarditis. But if you have a problem with your heart that affects normal Reference blood flow through the heart Opens New Window Reference Opens New Window, it is more likely that bacteria or fungi will attach to heart tissue. This puts you at a higher risk for endocarditis.
You have a higher risk of endocarditis if you have:
- Had endocarditis in the past.
- Reference Hemodialysis Opens New Window for kidney failure.
- Abnormal or damaged heart valves.
- An Reference artificial heart valve Opens New Window.
- A Reference congenital heart defect Opens New Window.
- Reference Hypertrophic cardiomyopathy Opens New Window.
- Injected illegal drugs using dirty needles or without cleaning the skin.
- Reference HIV Opens New Window.
Not all heart problems give you a higher risk of endocarditis. You do not have a higher risk if you have:
- Coronary artery bypass graft surgery (bypass surgery).
- Previous rheumatic fever without heart valve damage.
- A Reference pacemaker Opens New Window or an Reference implantable cardioverter-defibrillator (ICD) Opens New Window.
- A heart attack without other complications.
- Reference Mitral valve prolapse Opens New Window without Reference mitral valve regurgitation Opens New Window or unusually thickened valve leaflets.
- A coronary artery Reference stent Opens New Window.
What can you do if you are at risk for endocarditis?
If you have certain heart conditions, getting endocarditis is even more dangerous for you. These heart conditions include:
- Reference Artificial heart valves Opens New Window.
- Endocarditis in the past.
- Heart defects since birth (Reference congenital heart defects Opens New Window).
- Reference Heart valve Opens New Window 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. If you do not have these conditions, antibiotics are not likely to help you.
Procedures that may require antibiotics include:
- Certain dental work or dental surgery.
- Lung surgery.
- Surgery on infected skin, bone, or muscle tissue.
- Certain medical procedures, such as a Reference biopsy Opens New Window.
Practicing 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. The card states that you may 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.
- Chills and fever.
- Weight loss.
- Night sweats.
- Painful joints.
- Persistent cough and shortness of breath.
- Bleeding under the fingernails.
- Tiny purple and red spots under the skin.
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, Reference heart failure Opens New Window 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:
- Reference Abnormal heartbeat Opens New Window.
- Reference Stroke Opens New Window.
- Reference Kidney failure Opens New Window.
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 Reference heart murmur Opens New Window, an enlarged spleen, skin rashes, and bleeding under your nails.
Reference Blood cultures Opens New Window will be done to check for bacteria in your bloodstream. And other tests, such as an Reference echocardiogram Opens New Window, 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:
Living with endocarditis:
|By:||Reference Healthwise Staff||Last Revised: Reference November 18, 2011|
|Medical Review:||Reference E. Gregory Thompson, MD - Internal Medicine
Reference W. David Colby IV, MSc, MD, FRCPC - Infectious Disease