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What is endocarditis?

Endocarditisis 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 ofendocarditis .

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 valveproblems after a heart transplant.

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

Havinghypertrophic cardiomyopathy. Havinghemodialysis, which is a treatment to clean the blood, for people with kidney

failure.

Injecting street drugs using dirty needles or without cleaning the skin. HavingAIDS. Acquired immunodeficiency syndrome reduces your ability to fight

infection.

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



Artificial heart valves. Endocarditis in the past. Heart defects since birth (congenital heart defects).
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Heart valveproblems after a heart transplant.If you have any of these heart conditions, you may need to takeantibioticsbefore 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 abiopsy.

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 that 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-gradefeverandfatigue, 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. Persistentcoughand 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,heart failurecan

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:
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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, anenlarged spleen, skin rashes, and bleeding under your nails.

Blood cultureswill 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.

Symptoms

Most people withendocarditishave symptoms that begin within 2 weeks after becoming

infected. Vague, flu-like symptoms, such as a low-grade fever and fatigue, often occur first. But

infection with a powerful strain of bacteria may cause symptoms to be more severe (such as ahigh fever) and to appear much faster, within a few days. If symptoms persist, see your doctor,

especially if you are at a high risk for endocarditis.

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.



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

Other risk factors include:

Havinghypertrophic cardiomyopathy.

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

Your doctor can tell you whether you are atincreased risk for endocarditis. Tell all other health

professionals who treat you that you are at risk for endocarditis before you have any medical,

dental, or surgical procedures. Your doctor can give you a card to carry in your wallet that states

that you may need preventive antibiotics before having certain procedures

Exams and Tests

The first step in diagnosingendocarditisis a review of your medical history and a physical exam.

As part of your medical history, your doctor will ask you:

About your symptoms. If you have aheart murmuror have had valve replacement surgery. If you have any recent risk factors for a bacterial or fungal infection such as drug injection,

dental procedures, or a catheter (such as a catheter fordialysis).

As part of your physical exam, your doctor will:

Look in your eyes for small amounts of bleeding. Look at your skin for tiny purple or red spots, tender bumps, or painless red spots. Listen to your heart for a murmur. Listen to your lungs for any fluid buildup. Give you a neurologic exam to check for signs of astroke.

Other tests may be needed to diagnose endocarditis. They include:

Blood cultures. Several blood cultures are recommended to identify bacteria or fungi in thebloodstream.

1

But sometimes blood cultures fail to detect endocarditis. The cultures may failbecause you recently took antibiotics or the bacteria or fungi causing your endocarditis do not

grow well in a lab culture. If the blood cultures do not detect endocarditis, you may need further

testing.

Echocardiogram, including transthoracic echocardiogram (TTE) andtransesophagealechocardiogram(TEE). These tests use high-pitched sound waves to produce an image of the

heart. They can find infected areas, heart valve defects, and other abnormalities.
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You may need other tests to identifycomplications of endocarditis. These tests may include:

Chest X-ray, which can show whether your heart is enlarged or you have signs of heart failure. Electrocardiogram (EKG, ECG). An EKG can determine whether your heart rhythm is regular.

Endocarditis can causeabnormal heartbeatsor an abnormal heart rhythm (heart block).

Urinalysis, which checks for blood and protein in the urine. Computed tomographyor anMRI. These tests can tell if a blood clot caused by endocarditis has

caused astrokeor if the infection has spread to your brain.

Cardiac catheterization. This test may be useful if you need to have valve replacement surgerybecause of endocarditis. It may also be used before valve surgery to see if you havecoronary

artery diseasethat should be treated at the same time.

Treatment Overview

There are three main goals when treatingendocarditis:

Quickly destroy the infection. Repair or replace a heart valve, if needed. Treat complications.

Destroy the infection

If you have endocarditis, you will need several weeks of treatment with one or more antibiotics.

At first you will be treated in the hospital because the antibiotics are given through a vein (by

IV), and you may need other tests during treatment. After your fever is gone and you are stable,

you may be able to continue IV antibiotics at home with the help of a home health nurse.

Antibiotics are usually given for 4 to 8 weeks, but some people may require only 2 to 4 weeks of

treatment. How long you take antibiotics may depend on what type of bacteria is causing the

infection or whether you have an infection of artificial heart valves. For example, you may take

antibiotics for a longer time because you have artificial heart valves. The antibiotics must be

given long enough and at a strong enough dose to destroy all of the bacteria.

After the first IV antibiotics, your doctor may want you to take antibiotic pills. If so, take them

exactly as prescribed until they are gone. If your symptoms return, call your doctor right away.

You probably will need more antibiotics if testing shows that the bacteria were not completely

destroyed.

If endocarditis is caused by a fungus, you may need intravenous antifungal medicine. And heart

valve surgery usually is required for endocarditis caused by a fungus.

Surgery

If your heart valve becomes severely damaged fromendocarditisor if infection develops in an

artificial heart valve, you may need surgery to repair or replace the valve.
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You may need surgery if you have:

Heart failure. A fungal infection. Anabscessaround a valve in your heart. Damage to the electrical system of your heart. Infected tissue that repeatedly breaks off the valve and travels to other parts of your body (for

example, lungs, brain, or kidneys).

Complications

If you havecomplications from endocarditis, such asheart failureorstroke, you may need

treatment for these conditions.

Treatment for endocarditis is usually guided by aninfectious disease specialist. Acardiologist

may also be involved if your heart muscle or valves are damaged. You will need acardiovascular

surgeonif you have heart valve replacement surgery.

Home Treatment

After your condition has stabilized, you can probably go home where you may continue to

receive antibiotic treatment through a vein (by IV). A home health nurse will help with these

medicines. The nurse will teach you how to give yourself the antibiotics and how tocare for your

IV tube (catheter).

Be sure to tell your doctor if symptoms, such as a fever or chills, return or if you have any new

symptoms.

Preventing endocarditis

If you have a normal heart and valve structure, you have a low risk for developing endocarditis.

But if you have a problem with your heart that affects normal blood flow, it increases the

likelihood that bacteria or fungi will attach to heart tissue. This puts you at a high risk for

endocarditis.



Artificial heart valves. Endocarditis in the past. Heart defects since birth (congenital heart defects). Heart valveproblems after a heart transplant.
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If you have any of these heart conditions, you may need to take antibiotics before you have

certaindental or surgical proceduresthat could put bacteria or fungi into your blood. The

antibiotics lower your risk of getting endocarditis.

Your doctor can give you a card to carry in your wallet that states that you may need preventive

antibiotics before certain procedures.

If you are at increased risk for endocarditis, practice good oral hygiene. Floss your teeth daily,

and visit a dentist twice each year. For more information, see the topicGum Disease.

Also, if you have conditions such as AIDS that weaken your ability to fight disease, you are at

greater risk
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