Condition Basics

What is endocarditis?

Endocarditis is an infection of the heart valves or inner lining (endocardium) of the heart chambers. It occurs when germs, such as bacteria or fungi, get into the bloodstream and settle inside the heart, often on a valve.

It needs to be treated right away. If it isn't treated, endocarditis can cause death.

What are the symptoms?

Symptoms may appear quickly, within a few days of infection. In other cases, they may develop more slowly. The symptoms will get worse as the bacteria or fungi grow in your heart.

Symptoms may include:

• Flu-like symptoms such as fever, chills, night sweats, dizziness, and feeling tired. These are often the first symptoms.
• Shortness of breath.
• A cough.
• Muscle or joint pain.
• Blood under the fingernails or tiny purple and red spots under the skin.
• Weight loss.

Call your doctor right away if you have symptoms like these that don't go away, especially if you are at risk for endocarditis.

If endocarditis isn't treated right away, it can lead to more serious problems, such as:

• Heart failure.
• An abscess in the heart.
• Heart rhythm problems.
• Heart attack or stroke.
• Infections in other organs, such as the lungs, brain, or kidneys.

How is it diagnosed?

First, your doctor will ask about your medical history and your symptoms. The doctor will also do a physical exam to check for signs of the infection. These signs include a heart murmur, an enlarged spleen, and bleeding under the nails.

Your doctor may also do tests, such as:

• Blood cultures. These tests look for bacteria in your bloodstream.
• Echocardiogram. This is done to check your heart for problems such as infected areas or heart valve defects.
• An MRI test, a CT scan, or a PET (positron emission tomography) scan. These may be done as additional tests to check your heart for problems.
• Electrocardiogram (EKG or ECG). This test checks for heart rhythm problems.
• A chest X-ray. This is to see if your heart is enlarged or if you have signs of heart failure or lung problems.

How is endocarditis treated?

Endocarditis is usually treated with antibiotics or antifungals. You will probably need several weeks of treatment. The antibiotics must be given long enough and at a strong enough dose to destroy all of the bacteria.

At first you will be treated in the hospital. This is so that antibiotics can be given through a vein (I.V.). After your fever is gone and you are stable, you may be able to continue I.V. antibiotics at home. A home health nurse can help you with this.

After you have been treated with I.V. antibiotics, your doctor may want you to take antibiotic pills. If so, take them exactly as prescribed until they are gone. If your symptoms come back, call your doctor right away. You probably will need more antibiotics if testing shows that the bacteria were not completely destroyed.

Some people who have endocarditis need surgery to repair or replace a heart valve. Or they may need surgery to take care of an infection, such as an abscess, or to prevent complications.

You may have follow-up visits for months or years to check the health of your heart.

What increases your risk?

Your risk is higher if you have a problem that affects blood flow through your heart. That's because a blood flow problem makes it more likely that bacteria or fungi will attach to heart tissue. Some other things raise your risk too, because they can let bacteria or fungi enter your bloodstream.

You have a higher risk of endocarditis if you:

• Have had endocarditis in the past.
• Have an implanted heart device such as a pacemaker or implantable cardioverter-defibrillator (ICD).
• Have a hemodialysis access or a central vascular access device.
• Have abnormal or damaged heart valves.
• Have had a heart valve replaced or repaired.
• Have a congenital heart defect.
• Have injected drugs.
• Have had a recent dental or medical procedure.

Not all heart problems put you at higher risk for endocarditis. Talk to your doctor about your risk.

How can you prevent endocarditis?

Here are some ways you can prevent endocarditis:

• Practice good oral hygiene by brushing and flossing your teeth daily.
• See a dentist twice each year. Tell your dentist that you are at risk for this infection.
• Ask your doctor or dentist if you need antibiotics to prevent this infection. Find out when you will need to take them.

Your doctor may give you a card that says you may need preventive antibiotics before some procedures. You can keep it in your wallet.