Diseases & Conditions

Endocarditis

The inside of your heart contains four chambers and four valves lined by a thin membrane called the endocardium. Endocarditis is an infection of this inner lining.

Endocarditis typically occurs when bacteria or other germs from another part of your body, such as your mouth, spread through your bloodstream and attach to damaged areas in your heart. Left untreated, endocarditis can damage or destroy your heart valves. Endocarditis can be life-threatening.

Endocarditis is uncommon in people with healthy hearts. People at greatest risk of endocarditis have a damaged heart valve, an artificial heart valve or other heart defects.

Endocarditis may develop slowly or suddenly — depending on what's causing the infection and whether you have any underlying heart abnormalities.

Signs and symptoms of endocarditis may include:

• Fever
• Chills
• A new or changed heart murmur
• Fatigue
• Aching joints and muscles
• Night sweats
• Shortness of breath
• Paleness
• Persistent cough
• Swelling in your feet, legs or abdomen
• Unexplained weight loss
• Blood in your urine
• Tenderness in your spleen — an infection-fighting abdominal organ on your left side, just below your rib cage

Sometimes endocarditis causes red, tender spots under the skin of the fingers. These are known as Osler's nodes. You may notice tiny purple or red spots known as petechiae (puh-TE-ke-e) on other areas of the skin. Similar spots may appear in the whites of your eyes or inside your mouth.

Endocarditis occurs when germs enter your bloodstream, travel to your heart, and attach to abnormal heart valves or damaged heart tissue. Bacteria are the cause of most cases, but fungi or other microorganisms also may be responsible.

Sometimes the culprit is one of many common bacteria that live in your mouth, upper respiratory tract or other parts of your body. In other cases, the offending organism may gain entry to your bloodstream through:

• Common activities. Everyday activities such as brushing your teeth or chewing food can allow bacteria to enter your bloodstream — especially if your teeth and gums are in poor condition.
• An infection or other medical condition. Bacteria may spread from an infected area, such as a skin sore. Gum disease, a sexually transmitted disease or an intestinal disorder — such as inflammatory bowel disease — also may give bacteria the opportunity to enter your bloodstream.
• Catheters or needles. Bacteria can enter your body through a catheter — a thin tube that doctors sometimes use to inject or remove fluid from the body. Contaminated needles and syringes are a concern for people who use intravenous (IV) drugs.
• Certain dental or respiratory tract procedures. Some dental procedures may allow bacteria to enter your bloodstream.

Typically, your immune system destroys bacteria that make it into your bloodstream. Even if bacteria reach your heart, they may pass through without causing an infection.

Most people who develop endocarditis have a diseased or damaged heart valve — an ideal spot for bacteria to settle. This damaged tissue in the endocardium provides bacteria with the roughened surface they need to attach and multiply.

If you develop signs or symptoms of endocarditis, see your doctor right away — especially if you have risk factors for this serious infection. Signs and symptoms may include:

• Fever
• Chills
• A new or changed heart murmur
• Fatigue
• Aching joints and muscles
• Night sweats
• Shortness of breath
• Paleness
• Persistent cough
• Swelling in your feet, legs or abdomen
• Unexplained weight loss
• Blood seen during microscopic examination of your urine
• Tenderness in your spleen — an infection-fighting abdominal organ on your left side, just below your rib cage

Although less serious conditions can cause similar signs and symptoms, you won't know for sure until you see a doctor.

Endocarditis can cause clumps of bacteria and cellular debris (vegetations) to form in your heart at the site of the infection. These clumps can break loose and travel to your brain, lungs, abdominal organs or kidneys. This may cause various problems, including stroke or damage to other organs.

Left untreated, endocarditis can damage your heart valves and permanently destroy your heart's inner lining. This can cause your heart to work harder to pump blood eventually causing heart failure — a chronic condition in which your heart is unable to pump enough blood to meet your body's needs. If the infection progresses untreated, it's usually fatal.

If you have endocarditis, you may need high doses of intravenous antibiotics in the hospital. Blood tests may help identify the type of microorganism that's infecting your heart. This information will help your doctor choose the best antibiotic or combination of antibiotics to fight the infection.

You may need to take antibiotics for two to six weeks to clear up the infection. Once your fever and the worst of your signs and symptoms have passed, you may be able to leave the hospital and continue antibiotic therapy in an outpatient setting. You'll need to see your doctor regularly to make sure your treatment is working.

Report to your doctor any signs or symptoms that your infection is getting worse, such as:

• Fever
• Chills
• Headaches
• Joint pain
• Shortness of breath

Diarrhea, a rash, itching or joint pain may indicate a reaction to an antibiotic — another reason to call your doctor.

See your doctor immediately if you experience shortness of breath or swelling in your legs, ankles or feet. These signs and symptoms may indicate heart failure.

If the infection damages your heart valves, you may have symptoms and complications for years after treatment. Sometimes surgery is needed to treat persistent infections or replace a damaged valve.

If you're at risk of endocarditis, let all of your health care providers know. You may want to request an endocarditis wallet card from the American Heart Association. Check with your local chapter or print the card from the association's Web site.

To help prevent endocarditis, take good care of yourself. Pay special attention to your dental health. Brush and floss your teeth and gums often, and schedule regular dental checkups. Avoid procedures that may lead to skin infections, such as body piercing or tattoos. Seek prompt medical attention if you develop any type of skin infection or open cuts or sores that do not heal properly.