What Is Endocarditis? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Endocarditis is an infection of the endocardium, or the inner lining of the heart chambers and heart valves.

The condition is sometimes called infective endocarditis, and it can damage your heart, causing serious complications.

Though infective endocarditis is potentially life-threatening, most people who are treated with antibiotics recover.

Symptoms of endocarditis can range from mild to severe, and they may vary depending on the type of bacteria causing the infection and whether you have had heart problems in the past.

• Fever
• Chills
• Fatigue
• Muscle or joint aches
• Headaches
• Night sweats
• Shortness of breath and chest pain
• Swelling in feet, legs, or abdomen

• Unexplained weight loss
• Blood in the urine
• Red spots on the soles of your feet or palms of your hand
• Red, tender spots under the skin of your fingers and toes
• Tiny purple or red spots in the whites of your eyes or inside your mouth
• Tenderness in the spleen

• Everyday oral hygiene, such as brushing your teeth or flossing, can cause your gums to bleed, allowing bacteria to enter your bloodstream.
• Intravenous (IV) catheters, or thin tubes that healthcare providers use to inject fluid or medications from the body, can allow bacteria to enter the body and bloodstream. The longer a catheter is in place, the more likely an infection is to occur.
• An infection on or in your body, such as a skin sore, gum disease, or a sexually transmitted infection, may spread bacteria to your bloodstream.
• Certain dental procedures, such as tooth extractions, can cut your gums and allow bacteria to enter your bloodstream.
• Intravenous illegal drug use, such as heroin or cocaine, can lead to endocarditis if contaminated needles or syringes are used.
• Needles used for tattoos or piercings can allow bacteria to enter your bloodstream and lead to endocarditis.

• Damaged heart valves
• Artificial heart valves
• Some types of congenital heart defects (heart abnormalities present at birth)
• Implanted medical devices in the heart (such as a pacemaker)

• Blood tests will identify any bacteria or germs that are in your bloodstream. They will also allow your doctor to check for conditions that can be a sign of endocarditis, like anemia, which is a shortage of healthy red blood cells.
• Echocardiogram uses ultrasound waves to produce pictures of your heart to check for signs of infection.
• Electrocardiogram (ECG) can show your physician if something is affecting your heart’s electrical activity. This test involves sensors attached to your chest, arms, and legs that measure the timing of each electrical phase of your heartbeat.
• Chest X-ray will allow your doctor to see if an infection has caused your heart to become enlarged or has spread to your lungs.
• CT scan or MRI may be ordered if your doctor suspects an infection has spread to your brain or other parts of your body.

In more severe cases where damage is done to the heart valves, the effects of endocarditis can last for years. In some instances, surgery may be needed to correct the damaged heart valve.

Generally, people with endocarditis can expect to stay in the hospital for a week or more during the course of the antibiotic treatment. If your body responds well to treatment, you may be able to return home and continue to receive IV antibiotic therapy through home healthcare.

If endocarditis damages the heart valves, symptoms and complications may last for years. In these cases, sometimes surgery is needed to either repair the damaged valve or replace it with an artificial one.

Prevention of Endocarditis

Not all cases of endocarditis can be prevented.

In the past, prophylactic (preventive) antibiotic treatments were given to almost everyone with a congenital heart defect one hour before dental procedures, oral surgery, or operations on the gut, genitals, or urinary tract.

Now only people at the highest risk of endocarditis are given antibiotics before certain dental procedures.

Your doctor can help you figure out your risk for endocarditis and whether you need to take any prophylactic medications.

Keeping your mouth clean and healthy can reduce the risk of bacteria getting into your bloodstream.

These clumps, called vegetations, can break off and form blood clots. They can travel to other parts of your body where they can cause new infections or block blood flow.

If you have symptoms of endocarditis, it’s important to contact your doctor immediately.

The sooner you can begin treatment with antibiotics, the lower your risk of developing serious complications. Untreated endocarditis can turn fatal.

• Heart problems (heart murmur, heart failure, heart valve damage, abnormal heartbeat, heart attack)
• Meningitis or other brain infections
• Strokes or seizures
• Pulmonary embolism (sudden blockage of blood flow to the lungs)
• Pneumonia
• Damage to kidneys or spleen
• Need for high-risk removal of pacemaker or implantable cardioverter defibrillator
  

Estimates of the prevalence of endocarditis vary, but it’s a relatively rare disease.

Older estimates found that about 4 out of every 100,000 people are diagnosed with infective endocarditis each year in the United States.

Some newer research suggests that endocarditis may be more common than previously thought — and that the prevalence of endocarditis in the United States also may be increasing.

Endocarditis is more common in men than women.

According to the National Organization for Rare Disorders, no race or ethnicity is more affected than others by endocarditis. But research continues to show racial disparities in infectious disease complications.

The results showed that Black patients were more likely to die from endocarditis than white patients. They were also less likely to undergo valve repair or replacement surgeries.

While the researchers did not look at the underlying reasons for these disparities, they offered some theories. First, studies show Black Americans are known to have more cases of drug-resistant organisms, which makes an endocarditis infection more difficult to treat with antibiotics. Black patients are also less likely than whites to receive care at high-volume hospitals that carry out complex surgical procedures, including valve replacements. Rather, other research has found, Black Americans are more likely to have high-risk surgeries at lower quality hospitals.

Favorite Organizations for Endocarditis Information

American Heart Association (AHA)

The AHA is the nation’s oldest and largest nonprofit organization dedicated to patients with heart issues. Here you can find resources and connect with other patients dealing with heart-related problems. If you are at risk of endocarditis, your doctor can download and print out a wallet card from the AHA’s website stating extra precautions that should be taken before certain treatments.

National Organization for Rare Disorders (NORD)

NORD is a patient advocacy organization dedicated to individuals with rare disorders and conditions, including endocarditis. Get the essential facts about endocarditis on NORD’s website.

Mayo Clinic

The Mayo Clinic provides a complete overview of endocarditis. You can also find general tips on how to live a heart-healthy lifestyle, including ways to make your diet healthier and tips to get in more physical activity.

Additional reporting by Lindsey Konkel.