Endocarditis

Endocarditis is a life-threatening inflammation of the inner lining of your heart’s chambers and valves (endocardium). It’s usually caused by bacteria. When the inflammation is caused by infection, the condition is called infective endocarditis. Generally speaking, endocarditis is uncommon in people with healthy hearts.

Symptoms

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, like the flu or other infections like pneumonia. This is why many cases go undiagnosed.

Common symptoms of endocarditis include:

Heart murmur
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
Symptoms of stroke

Less common symptoms of endocarditis include:

Blood in 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

When to contact your doctor

The signs and symptoms of infectious endocarditis can vary greatly for individuals. They can also change over time, depending on the cause of your infection, heart health, and how long the infection has been active.

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 above 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.

Causes

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 sometimes fails.

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

Patients most at risk of developing endocarditis include those who have:

Acquired valve disease (for example, rheumatic heart disease) including mitral valve prolapse with valve regurgitation (leaking) and/or thickened valve leaflets
An artificial (prosthetic) heart valve, including bioprosthetic and homograft valves
Previous bacterial endocarditis
Certain congenital heart defects
Patients with devices exposed to blood flow such as pacemakers
Immunosuppressed patients
Patients who are intravenous drug abusers
Hypertrophic cardiomyopathy (HCM) patients

Management and Treatment

Once endocarditis occurs, quick treatment is necessary to prevent damage to the heart valves and more serious complications. Treatment may include:

Antibiotics:

If your endocarditis is caused by bacteria, it will be treated with intravenous antibiotic therapy. IV antibiotics are usually given for as long as 6 weeks to cure the infection. Symptoms are monitored throughout therapy and blood cultures are repeated to determine the effectiveness of treatment.

Surgery:

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.
After treatment is completed, the patient should be worked up for sources of bacteria and these (for example, dental infections) should be treated. In the future, the patient should take antibiotics prophylactically, as prescribed by your doctor.

Complications

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 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
Lungs
Brain
Bones, particularly your spinal column
Additional severe complications that can arise from endocarditis include stroke, heart attack and heart failure.

Prevention

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, and contact your doctor if needed.

Certain bacteria causing endocarditis may be suggestive of a tumor in the bowels, so blood cultures for bacteria should always be taken before treating endocarditis with antibiotics. If these bacteria are present, a thorough search for cancer should commence and include a CT scan and endoscopy.

You should also avoid:

Body piercings
Tattoos
IV drug use
Any procedure that might allow germs to enter your blood