Doctor checking patient's heart

Bacterial infections can take a toll on your body. In some cases, infections can damage your heart causing a condition known as endocarditis. While rare, it’s a potentially fatal condition.

What Is Endocarditis?

Endocarditis is when the lining of your heart — the endocardium — becomes inflamed. It also usually affects your heart’s valves and blood vessels.

Causes of Endocarditis

The most common cause of endocarditis is a bacterial infection. It happens when bacteria enters the bloodstream and settles in the lining of your heart, heart valves, and blood vessels.

Bacteria can get into your bloodstream several ways:

  • Injury to your skin, including cuts, scrapes, and skin infections.
  • Injury to your mouth or gums, including from every day activity such as brushing your teeth.
  • Inflammation of your gums (known as gingivitis) or other dental infections.
  • Poor oral hygiene.
  • Infections in other parts of your body, such as from an IV catheter.
  • Using a contaminated needle.
  • Contracting a sexually transmitted disease.

In rare cases, fungi can also cause endocarditis.

Another common term for endocarditis is infective endocarditis (IE). Bacterial endocarditis is also used to describe endocarditis caused by bacteria or other microorganisms.

There’s also non-infective endocarditis. This happens when sterile blood clots attach to heart walls and valves. Eventually, noninfective endocarditis can turn into IE if microorganisms attach to the blood clots.

While rare, endocarditis, or IE, is a serious condition that is always fatal if not treated. Here’s what you need to know about IE to protect yourself.

Signs and Symptoms of Infective Endocarditis

Because symptoms are often mild at first, you may not know you have endocarditis right away. It can resemble other illnesses, such as the flu. That’s why IE often goes undetected and undiagnosed.

Symptoms of IE can develop and worsen over time. Some people can develop severe symptoms suddenly. Signs and symptoms of endocarditis include:

  • New or worsening heart murmurs.
  • Fever or chills.
  • Joint or muscle pain and numbness.
  • Pale skin.
  • Painful nodules under the skin.
  • Reddish spots on your skin and whites of your eyes.
  • Red streaks under your fingernails.
  • Confusion.
  • Stomach pain.
  • Blood in urine.
  • Enlarged spleen that’s tender to the touch.

It’s important to contact your doctor right away if you have a persistent fever or unusual fatigue that won’t go away.

Types of Endocarditis

Symptoms can depend on the type of infective endocarditis, which include:

  • Acute bacterial endocarditis. Symptoms begin suddenly and include fatigue, a high fever (102 to 104 degrees Fahrenheit), and fast heart rate (greater than 100 beats per minute). It causes rapid and extensive heart valve damage, which can lead to heart failure.
  • Subacute bacterial endocarditis. Also known as chronic IE, symptoms occur gradually over weeks or months. They include fatigue, sweating, mild fever, a moderately fast heart rate, weight loss, and a low red blood cell count.

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Endocarditis Risk Factors

Infective endocarditis can happen to anyone, but there are several factors that can increase your risk.

You are at higher risk for endocarditis if you:

  • Have an artificial heart valve, pacemaker, or defibrillator.
  • Use intravenous drugs.
  • Are immunocompromised.
  • Have a history of valvular disease, including aortic valve disease, mitral regurgitation, mitral valve prolapse, and rheumatic heart disease.
  • Have a congenital heart disease, including aortic stenosis, bicuspid aortic valve, pulmonary stenosis, and ventricular septal defect.
  • Have a history of infective endocarditis.
  • Recently had or are undergoing certain invasive dental procedures, such as a root canal.
  • Recently had certain medical or surgical procedures, including heart valve surgery and open-heart surgery.
  • Are on hemodialysis.
  • Have a fixed intravenous catheter.
  • Develop sepsis, a severe blood infection.
  • Are age 60 or older.
  • Are male. Endocarditis affects twice as many men as women.

Diagnosing Endocarditis

Endocarditis often goes undiagnosed because symptoms are vague, mild, or similar to other illnesses. If your doctor suspects endocarditis, they may order blood work to look for signs of disease-causing bacteria. They may also use one or more of the following tests to diagnose you:

  • Transthoracic echocardiography. The doctor places an ultrasound probe on your chest to look at your heart and see how it functions.
  • Transesophageal echocardiography. The doctor passes an ultrasound probe down your throat into your esophagus behind the heart. This allows them to get additional images that they were not available with the transthoracic test.
  • Computed tomography (CT). Doctors sometimes order CT scans when transesophageal echocardiography isn’t enough.
  • Positron emission tomography (PET). Doctors are more likely to use PET scans to diagnose infective endocarditis if you have an artificial heart valve or other heart devices.

How Endocarditis Harms Your Body

Whether symptoms come on suddenly or gradually, infective endocarditis can cause blood clots and blockages in your arteries. This can lead to stroke or heart attack.

Sometimes, pieces of the infected heart valves can break loose. These broken pieces, called emboli, can lodge in organs like the spleen or kidneys, causing serious damage.

Treatment for Endocarditis

If your doctor suspects endocarditis, they will likely hospitalize you right away to get you the proper diagnosis and treatment as soon as possible. Treatment includes:

Antibiotics

Your blood test will help your doctor determine which antibiotics will be most effective. Doctors treat endocarditis with high doses of antibiotics given in your vein (intravenously). IV antibiotic therapy usually starts at the hospital and typically lasts from 2 to 8 weeks.

In some cases, you can continue the IV treatment at home with the help of a skilled nurse. With some infections, you can eventually switch to oral antibiotics.

Heart surgery

Antibiotics aren’t always enough to cure infective endocarditis. Sometimes the condition can damage one or more of your heart valves. In this case, you might need heart surgery to repair or replace damaged valves.

Dental treatment

Mouth and gum disease, such as tooth abscess or gingivitis, can cause bacteria to enter your bloodstream. The focus of dental treatment is to fix the dental problem contributing to the bacteria.

Catheter removal

If a catheter is the cause of the infection, your doctor will remove it.

Preventing Endocarditis

Preventing injury and infection to your skin and mouth is one way everyone can prevent IE.

If you’re at high risk for infective endocarditis, your doctor may prescribe antibiotics before certain medical, surgical, and dental procedures.

Prevention measures before dental procedures

Maintaining good oral hygiene is one way for everyone to prevent IE.

In rare cases, certain dental procedures, such as those affecting your gums and dental roots, can cause bacteria to enter your bloodstream. Taking an antibiotic one hour before these procedures can reduce your risk of developing IE. This is known as antibiotic prophylaxis.

For these procedures, the American Heart Association guidelines say it’s reasonable to use antibiotic prophylaxis for those with heart valve disease who also have the following:

  • Prosthetic (artificial) cardiac valves, including transcatheter-implanted prostheses and homografts.
  • Artificial material used for heart valve repair, such as annuloplasty rings, chords, or clips.
  • Previous IE.
  • Unrepaired cyanotic congenital heart defect (where oxygen levels are lower than normal).
  • Repaired congenital heart defect, with residual shunts or valvular regurgitation near the artificial valve or device.
  • Cardiac transplant with valve regurgitation due to a structurally abnormal valve.

For any other type of congenital heart disease, the AHA doesn’t recommend antibiotic prophylaxis before dental procedures.

Sources

Infective Endocarditis. American Heart Association. Link.

What is Infective Endocarditis. American Heart Association. Link.

Bacterial Endocarditis. StatPearls. Link.

Geographic Trends, Patient Characteristics, and Outcomes of Infective Endocarditis Associated With Drug Abuse in the United States From 2002 to 2016. Link.

Infective Endocarditis. Merck Manuals. Link.

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