Infective Endocarditis

What is infective endocarditis?

The endocardium is a thin layer of tissue that lines the inside of your heart. It covers the walls of your heart chambers (rooms), and your heart valves. Your heart valves act as one-way doors to direct the flow of blood through the heart. Infective endocarditis occurs when this lining becomes infected. The infection causes inflammation of the endocardium. The inflammation can happen anywhere in the heart, but usually affects the heart valves.

What causes infective endocarditis?

• Infective endocarditis is often caused by germs called bacteria. There are different kinds of bacteria that can cause endocarditis. Some bacteria are worse than others and may cause severe endocarditis. Other kinds of germs, such as viruses or fungi, may also cause infective endocarditis.
  
  
• Endocarditis is rare in people with normal hearts. Certain heart problems may allow bacteria in your blood to become stuck in the heart and cause an infection. Those at risk include people who have had heart problems such as mitral valve prolapse or heart valve surgery. Heart problems, such as an enlarged heart or being born with a heart defect, also increase this risk. Having had rheumatic fever as a child may have damaged your heart or heart valves. Other things that may cause or increase your risk of endocarditis include the following.
  
  
  • Certain health problems, such as having diabetes or being on dialysis for kidney problems. Having a long-term medical device under the skin, such as a central venous catheter, also increases your risk.
    
    
  • Certain surgeries or medical procedures. Also, having a baby at the same time you have an infection may increase your risk.
    
    
  • Having bad teeth or not keeping your teeth and gums clean. Dental procedures can also cause germs to break away from your gums and teeth. The bacteria may get into the blood and may travel to your heart.
    
    
  • Urinary procedures, such as having a catheter in your bladder.
    
    
  • Using IV (injected) street drugs.
    
    
  • Having immune system problems, such as HIV infection, certain types of cancer, or an organ transplant.

What are the signs and symptoms of infective endocarditis?

• The symptoms you have may depend on whether your infective endocarditis is acute or subacute. The symptoms of acute endocarditis may start or worsen quickly. Also, the infection may be more likely to spread to other parts of the body with acute endocarditis. Subacute endocarditis symptoms may happen more slowly and be milder.
  
  
• Your symptoms may depend on what germ is causing your infection, and how bad your endocarditis is. Your symptoms may also depend on the part of the heart affected, and your general health. Your symptoms may include one or more of the following:
  
  
  • Coughing and shortness of breath. You may even cough up bloody sputum (mucus) from your lungs.
    
    
  • Chest pain or irregular heartbeats. Caregivers may also hear extra heart sounds or murmurs when listening to your heart.
    
    
  • Fever, chills, sweating, and night sweats.
    
    
  • Headaches, back pain, abdominal pain, or muscle and joint aches. You may have swelling in your abdomen or legs.
    
    
  • Bloody urine.
    
    
  • Nausea and vomiting. You may not want to eat, and you may lose weight.
    
    
  • Blood in the whites of your eyes, or small red or purple dots on your skin. Red spots may happen on your fingers, toes, or under your fingernails. These spots may or may not be tender.
    
    
  • New problems with movement or feeling in your body. This may happen if your endocarditis causes problems with blood circulation in your body. You may have pale or blue skin and tenderness in your fingers or toes.

What other health problems may infective endocarditis cause?

Infective endocarditis may cause problems or damage elsewhere in your body. The risk of these problems is decreased if your endocarditis is treated early. Other health problems you may have because of your endocarditis include the following:

• Kidney problems. You may need dialysis to clean your blood if your kidneys stop working.
  
  
• New or worsening heart problems. Examples include heart valve problems or heart failure. You may have dangerous heart rhythms.
  
  
• The endocarditis may cause blood clots or plaque (growths) in your heart. The clots or plaque may break off and go to the brain, lungs, kidneys, or other parts of the body. This can cause problems that may be serious, even life threatening.
  
  
• The infection of the heart lining may spread elsewhere in the body. For example, it may spread to the blood, the heart muscle itself, or other organs. This spreading infection may be dangerous or make you very sick.

How is infective endocarditis diagnosed?

Your caregiver will examine you and review your medical history and symptoms. Tests may be done on your blood and urine. You may need an ultrasound of your heart called an echocardiogram. You may need an electrocardiogram, also called an EKG or ECG. An EKG is a test that senses the electrical activity of your heart muscle. A chest x-ray may be done to check your heart and lungs. Other tests may be done to help caregivers treat your endocarditis. You may need certain tests more than once, or new tests over time as caregivers continue to treat you.

How is infective endocarditis treated?

Treatment may depend on what is causing your endocarditis, how bad it is, and your general health. You may need to stay in the hospital for tests and treatment. Antibiotics may be given in the vein to clear up the infection that is causing the endocarditis. Medicines may be given to help your heart, blood pressure, and body fluid balance. You may need aspirin or blood thinning medicine to prevent blood clots. You may need medicine to help you breathe, or to decrease pain. Oxygen may also help you breathe easier and help your heart. Other treatments that you may need depend on the problems your infective endocarditis has caused. For example, you may need surgery to replace a damaged heart valve.

What are the risks of infective endocarditis?

Infective endocarditis and the health problems it may cause can be serious, even life threatening. Your risks of long-term problems decrease with early treatment. Even with treatment, your symptoms may come back. Certain heart problems may increase your risk of getting endocarditis again. Having had endocarditis in the past increases your risk of getting endocarditis again.

What can I do to help prevent infective endocarditis?

The following may help decrease your risk of getting infective endocarditis:

• Keep your teeth and gums healthy. Brush your teeth two to three times every day. It is best to do this after meals. Gently brush your teeth and gums using a clean toothbrush with soft bristles. See your dentist for regular checkups. Tell your dental caregivers that you had endocarditis in the past.
  
  
• Ask your caregiver if you should take antibiotic medicine before having certain procedures. Some procedures may allow germs to get into your blood and travel to your heart. You may need to take antibiotic medicine before certain dental or medical procedures to help prevent this. Tell caregivers about the heart problems and surgeries you have had in the past.

Where can I find more information?

Contact the following:

• American Heart Association
  7272 Greenville Avenue
  Dallas , TX 75231-4596
  Phone: 1- 800 - 242-8721
  Web Address: http://www.heart.org
  

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Learn more about Infective Endocarditis