What is endocarditis?
Endocarditis is inflammation of your heart’s inner lining, called the endocardium. It’s usually caused by bacteria. When the inflammation is caused by infection, the condition is called infective endocarditis. Endocarditis is uncommon in people with healthy hearts.
The 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 other infections, such as pneumonia. However, some people experience severe symptoms that appear suddenly. These symptoms may be due to inflammation or the associated damage it causes.
Common symptoms of endocarditis include:
- heart murmur, which is an abnormal heart sound of turbulent blood flow through the heart
- pale skin
- fever or chills
- night sweats
- muscle or joint pain
- nausea or decreased appetite
- a full feeling in the upper left part of your abdomen
- unintentional weight loss
- swollen feet, legs, or abdomen
- cough or shortness of breath
Less common symptoms of endocarditis include:
- blood in your urine
- weight loss
- an enlarged spleen, which may be tender to touch
Changes in the skin may also occur, including:
- tender red or purple spots below the skin of fingers or toes
- tiny red or purple spots from blood cells that leaked out of ruptured capillary vessels, which usually appear on the whites of the eyes, inside the cheeks, on the roof of the mouth, or on the chest
The signs and symptoms of infectious endocarditis vary greatly from person to person. They can change over time, and they depend on the cause of your infection, heart health, and how long the infection has been present. If you have a history of heart problems, heart surgery, or prior endocarditis, you should contact your doctor immediately if you have any of these symptoms. It’s especially important to contact your doctor if you have a constant fever that will not break or you’re unusually tired and don’t know why.
The main cause of endocarditis is an overgrowth of bacteria. Although these bacteria normally live on the inside or outside surfaces of your body, you might bring them inside to your bloodstream by eating or drinking. Bacteria could also enter through cuts in your skin or oral cavity. Your immune system normally fights off germs before they cause a problem, but this process fails in some people.
In the case of infective endocarditis, the germs travel through your bloodstream and into your heart, where they multiply and cause inflammation. Endocarditis can also be caused by fungi or other germs.
Eating and drinking aren’t the only ways that germs can enter your body. They can also get into your bloodstream through:
- brushing your teeth
- having poor oral hygiene or gum disease
- having a dental procedure that cuts your gums
- contracting a sexually transmitted disease
- using a contaminated needle
- through an indwelling urinary catheter or intravenous catheter
Risk factors for developing endocarditis include the following:
- injecting illicit intravenous drugs with a needle contaminated with bacteria or fungi
- scarring caused by heart valve damage, which allows bacteria or germs to grow
- tissue damage from having endocarditis in the past
- having a heart defect
- having an artificial heart valve replacement
Your doctor will go over your symptoms and medical history before conducting any tests. After this review, they’ll use a stethoscope to listen to your heart. The following tests may also be done:
If your doctor suspects you have endocarditis, a blood culture test will be ordered to confirm whether bacteria, fungi, or other microorganisms are causing it. Other blood tests can also reveal if your symptoms are caused by another condition, such as anemia.
A transthoracic echocardiogram is a non-radiating imaging test used to view your heart and its valves. This test uses ultrasound waves to create an image of your heart, with the imaging probe placed on the front of your chest. Your doctor can use this imaging test to look for signs of damage or abnormal movements of your heart.
When a transthoracic echocardiogram doesn’t provide enough information to assess your heart accurately, your doctor might order an additional imaging test called a transesophageal echocardiogram. This is used to view your heart by way of your esophagus.
An electrocardiogram (ECG or EKG) may be requested to get a better view of your heart’s electrical activity. This test can detect an abnormal heart rhythm or rate. A technician will attach 12 to 15 soft electrodes to your skin. These electrodes are attached to electrical leads (wires), which are then attached to the EKG machine.
A collapsed lung or other lung problems can cause some of the same symptoms as endocarditis. A chest X-ray may be used to view your lungs and see if they’ve collapsed or if fluid has built up in them. A buildup of fluid is called pulmonary edema. The X-ray can help your doctor tell the difference between endocarditis and other conditions involving with your lungs.
If your endocarditis is caused by bacteria, it will be treated with intravenous antibiotic therapy. Your doctor will advise you to take antibiotics until your infection and related inflammation are effectively treated. You will likely receive these in a hospital for at least a week, until you show signs of improvement. You will need to continue antibiotic therapy upon discharge from the hospital. You may be able to transition to oral antibiotics later in your treatment. Antibiotic therapy typically takes up to
Prolonged infective endocarditis or damaged heart valves caused by endocarditis may require surgery to correct. Surgery may be done to remove any dead tissue, scar tissue, fluid buildup, or debris from infected tissue. Surgery may also be done to repair or remove your damaged heart valve, and replace it with either man-made material or animal tissue.
Complications may develop from damage caused by your infection. These can include an abnormal heart rhythm, such as atrial fibrillation, blood clots, other organ injury, and hyperbilirubinemia with jaundice. Infected blood can also cause emboli, or clots, to travel to other parts of your body.
Other organs that can be affected include:
- kidneys, which may become inflamed, causing a condition called glomerulonephritis
- bones, particularly your spinal column, which may become infected, causing osteomyelitis
Bacteria or fungi can circulate from your heart and affect these areas. These germs can also cause abscesses to develop in your organs or other parts of your body.
Additional severe complications that can arise from endocarditis include stroke and heart failure.
Having good oral hygiene and keeping regular dental appointments can help lower the risk of bacteria building up in your mouth and getting into your bloodstream. This reduces your risk of developing endocarditis from an oral infection or injury. 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 congenital heart disease, a heart surgery, or endocarditis, 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.
You should also avoid:
- body piercings
- IV drug use
- any procedure that might allow germs to enter your blood