What Is Infective Endocarditis?

Infective endocarditis is an infection in the heart valves or endocardium. The endocardium is the lining of the heart. This condition is usually caused by bacteria entering the bloodstream and infecting the heart. Bacteria may originate in the:

  • mouth
  • skin
  • intestines
  • respiratory system
  • urinary tract

When this condition is caused by bacteria, it is also known as bacterial endocarditis. In rare cases it can also be caused by fungi or other microorganisms.

This is a serious condition that requires prompt medical treatment. If left untreated, the infection can damage your heart valves. This can lead to problems including:

  • stroke
  • damage to other organs
  • heart failure
  • death

This condition is rare in individuals with healthy hearts. People who have other heart diseases or conditions are at higher risk.

If you are at high risk for infective endocarditis, you may need antibiotics before certain medical and dental procedures. Antibiotics help stop bacteria from entering your bloodstream and causing infection. Talk to your surgeon or dentist before any surgical procedure.

Who Is at High Risk for Infective Endocarditis?

You may be at risk for this condition if you have:

  • artificial heart valves
  • congenital heart disease
  • heart valve disease
  • damaged heart valves
  • hypertrophic cardiomyopathy
  • a history of endocarditis

The risk of infective endocarditis is higher after procedures that allow bacteria access to the bloodstream. These include:

  • dental procedures involving the gums
  • insertion of catheters or needles
  • procedures to treat infections

These procedures do not put most healthy people at risk. However, people who have one or more risk factors for infective endocarditis need to be more careful. If you need one of these procedures, talk to your doctor first. You may be put on antibiotics before your visit.

What Are the Symptoms of Infective Endocarditis?

Symptoms vary from person to person. In some people they come on suddenly. In other people, symptoms develop more slowly. Talk to your doctor if you experience any of the symptoms below. People at high risk of endocarditis should take particular care.

Symptoms may include:

  • fever
  • chest pain
  • weakness
  • blood in urine
  • chills
  • sweating
  • red skin rash
  • white spots in mouth or on tongue
  • pain and swelling in joints
  • muscle aches and tenderness
  • abnormal urine color
  • fatigue
  • cough
  • shortness of breath
  • sore throat
  • sinus congestion and headache
  • nausea or vomiting
  • weight loss

Infective endocarditis can be life threatening if not treated promptly. Unfortunately, signs of infective endocarditis can resemble many other illnesses. Talk to your doctor immediately if you experience any of the above symptoms.

Testing for and Diagnosis of Infective Endocarditis

When you visit your doctor, you will first be asked to describe your symptoms. Then your doctor will perform a physical examination. He or she will listen to your heart with a stethoscope. This checks for sounds of a murmur, which may be present with infective endocarditis. Your doctor may also check for a fever and feel for an enlarged spleen by pressing on your left upper abdomen.

If your doctor suspects infective endocarditis, your blood will be tested for bacteria. A complete blood count (CBC) may also be used to check for anemia. A shortage of red blood cells can occur with infective endocarditis.

Your doctor may order an echocardiogram. This is an ultrasound of the heart. It uses sound waves to produce an image. The ultrasound wand may be placed on your chest. Alternatively, a smaller device may be threaded down your throat and into your esophagus. This can offer a more detailed image.

The echocardiogram looks for damaged tissue, holes, or other structural changes in your heart valve.

Your doctor may also order an electrocardiogram (ECG). An ECG monitors electrical activity in your heart. This painless test can find an irregular heartbeat caused by endocarditis.

Imaging tests can check if your heart has enlarged. They may also be able to detect signs that infection has spread to other areas of your body. Such tests include:

  • chest X-ray
  • computed tomography (CT) scan
  • magnetic resonance imaging (MRI)

If you are diagnosed with this condition, you will be immediately admitted to the hospital for treatment.

Treating Infective Endocarditis

Infective endocarditis can be life threatening. It can cause irreversible damage to the heart. Hospital treatment is necessary to prevent the infection from getting worse and causing complications.

Antibiotics and Initial Treatment

While in the hospital, your vital signs will be monitored. You will be given antibiotics intravenously (IV). Once you go home, you will continue with oral or IV antibiotics for at least four weeks. During this time, you will keep visiting your doctor. Regular blood tests will check that the infection is going away.

Surgery

Surgery may be needed if your heart valves have been damaged. Your surgeon may recommend repairing the heart valve. The valve can also be replaced using a new valve made from either animal tissue or artificial materials.

Surgery may also be necessary if the antibiotics are not working or if the infection is fungal. Anti-fungal medications are not always effective for infections in the heart.

Recovery and Outlook

If left untreated, this condition will be fatal. However, most individuals are able to recover with antibiotic treatment. The chance of recovery depends on factors including your age and the cause of your infection. In addition, patients who get early treatment have a better chance of making a full recovery.

If surgery was necessary, it may take you longer to recover completely.