Endocarditis

Written by April Kahn | Published on August 7, 2012
Medically Reviewed by Brenda B. Spriggs, MD, MPH, FACP

What is Endocarditis?

Endocarditis is inflammation of the heart’s inner lining, called the endocardium. This condition is also called infective endocarditis. Endocarditis is uncommon in people with healthy hearts. In a study published in the Canadian Journal of Cardiology, it was noted that between 1960 and 1999 there were only 36 reported cases of endocarditis in people with normal hearts (Ramadan, et al., 2000 Oct).

Risk Factors for Endocarditis

Risk factors for developing endocarditis include:

Drug Use

Injecting illicit drugs with a needle contaminated with bacteria or fungi can cause endocarditis. The germs pass into the bloodstream, and then travel to the heart.

Damaged Valves

Scarring caused by heart valve damage is a perfect place for bacteria or other germs to grow.

Previous Episodes of Endocarditis

If you’ve had endocarditis before, you are at risk for having it again because of tissue damage.

Being Born With a Heart Defect

Having a heart defect increases your risk of developing endocarditis.

Prosthetic Heart Valves

The highest risk for getting endocarditis is during the first year after receiving an artificial heart valve.

How Does Endocarditis Develop?

The main cause of endocarditis is an overgrowth of bacteria. Although these bacteria normally live on the outside of the body, you might bring them inside by eating or drinking, or through cuts in your skin. Your immune system normally fights off foreign germs before they cause a problem; however, in some people this process fails. In the case of endocarditis, the germs travel through the bloodstream and into the heart, where they multiply and cause inflammation.

Endocarditis can also be caused by a fungus or other germs, and in some cases, there is no known cause.

Eating and drinking aren’t the only ways that bacteria can enter your body. They can also get into your bloodstream through:

  • brushing your teeth
  • having poor oral hygiene or gum disease
  • contracting a sexually transmitted disease
  • using a contaminated needle
  • wearing a catheter
  • having a dental procedure that cuts your gums

How to Identify the Symptoms of Endocarditis

Symptoms of endocarditis aren’t always severe, and they may develop slowly over time. In the early stages of endocarditis the symptoms are similar to many other illnesses. This is why many cases go undiagnosed. Many of the symptoms are similar to cases of the flu or general infections such as pneumonia. However, some people experience severe symptoms that appear suddenly. These symptoms may be due to inflammation or the damage it causes.

Common symptoms of endocarditis include:

  • pale skin
  • fever
  • chills
  • night sweats
  • muscle or joint pain
  • nausea
  • decreased appetite
  • full feeling in upper-left part of the stomach
  • weight loss

Severe symptoms include:

  • blood in your urine
  • swollen feet
  • swollen legs
  • swollen stomach
  • shortness of breath
  • cough
  • weight loss
  • enlarged spleen (may be tender to touch) heart murmur (unusual sounding heartbeat)

Changes in the skin may also occur, which include:

  • red or purple spots on or under your fingers or toes
  • broken blood vessels that appear as red spots (usually on the whites of your eyes, inside of your cheeks, roof of your mouth, and on your chest)

The signs and symptoms of endocarditis vary greatly from person to person. They can change over time, and depend on the germ that caused the infection. If you have a history of heart problems, heart surgery, or have had endocarditis before, contact your doctor immediately if you have any of these symptoms, especially a fever that has gone on longer than three days or if you are unusually tired and don’t know why.

Testing for and Diagnosing Endocarditis

Your doctor will go over your symptoms and medical history before conducting any tests. After this review, he or she will use a stethoscope to listen to your heart.

If your doctor suspects endocarditis, a blood test will be ordered to confirm whether a bacteria, fungus, or microorganism is to blame. A blood test can also reveal if the symptoms are caused by another condition such as anemia.

An echocardiogram is an imaging test used to view the heart and its valves. This test uses ultrasound waves to create an image of the heart. The doctor uses this imaging test to look for signs of damage or sluggish movements in the heart.

When an echocardiogram doesn’t provide enough information to accurately assess your heart, your doctor might order an additional imaging test called a transesophageal echocardiogram. This imaging test is used to view the heart by way of your throat. This test is performed by inserting a thin probe down the throat to get a more detailed view of the heart. The doctor (or lab technician) will spray numbing medication on the back of the throat to minimize discomfort.

An electrocardiogram may be requested to better view the heart. This test can also detect an abnormal heart rhythm.

A collapsed lung can cause many of the same symptoms as endocarditis. If your doctor suspects this, a chest X-ray may be used to view the lungs to see if they have collapsed or if fluid has built up in the lungs (pulmonary edema). This helps tell the difference between endocarditis and a collapsed lung.

How Is Endocarditis Treated?

Endocarditis caused by bacteria is treated with antibiotics. These drugs are taken until the infection and inflammation are gone. This normally takes six weeks. If the infection is advanced, you may receive these antibiotics intravenously in a hospital until you show signs of improvement.

Damaged heart valves caused by endocarditis may require surgery to correct. Surgery is used to remove damaged heart valves and to replace them with artificial valves. In milder cases, the damaged area of the valve is removed and replaced with manmade material or animal tissue.

Complications and Future Health Risks Caused by Endocarditis

Complications may develop from damage caused by the infection. These can include an abnormal heart rhythm such as atrial fibrillation, blood clots, and jaundice. This damage isn’t just confined to the heart, where endocarditis can result in damaged heart valves—infected blood can also cause emboli (clots) to travel to other parts of the body.

Organs that can be affected are:

  • kidneys (inflammation of tiny kidney vessels or glomeruli- glomerulonephritis)
  • lungs (infection with emboli (clots)
  • brain (damaged and infected with emboli (clots)
  • abdominal organs
  • bones (osteomyelitis—infection of bones, typically the vertebral bodies of the spinal column)

Bacteria can escape from the heart and affect these areas, but the bacteria can also cause abscesses to develop in these organs or other parts of the body.

Some severe complications that can arise from endocarditis include stroke and heart failure.

Tips to Prevent Endocarditis

Having good oral hygiene and keeping regular dental appointments can eliminate some of the harmful bacteria that can build up in your mouth. This reduces the risk of developing endocarditis due to swallowing these bacteria. If you’ve undergone a dental treatment that was followed up with antibiotics, make sure to take your antibiotics as directed.

If you have a history of heart disease, heart surgery, or have had endocarditis before, be on the watch for the signs and symptoms of endocarditis. Pay special attention to a persistent fever and unexplained fatigue. Contact your doctor as soon as possible if you have any of these symptoms. Also avoid body piercing, tattoos, IV drug use, and any type of procedure that might allow germs to enter your blood.

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