Learn what causes this infection of the inner lining of the heart chambers and valves (endocardium) and find out how to prevent and treat it.
Endocarditis is a life-threatening inflammation of the inner lining of the heart's chambers and valves. This lining is called the endocardium.
Endocarditis is usually caused by an infection. Bacteria, fungi or other germs get into the bloodstream and attach to damaged areas in the heart. Things that make you more likely to get endocarditis are artificial heart valves, damaged heart valves or other heart defects.
Without quick treatment, endocarditis can damage or destroy the heart valves. Treatments for endocarditis include medications and surgery.
Endocarditis occurs when bacteria or other germs enter the bloodstream and travel to the heart. The germs then stick to damaged heart valves or damaged heart tissue.
Symptoms of endocarditis can vary from person to person. Endocarditis may develop slowly or suddenly. It depends on the type of germs causing the infection and whether there are other heart problems.
Common symptoms of endocarditis include:
Less common endocarditis symptoms can include:
If you have symptoms of endocarditis, see your health care provider as soon as possible — especially if you have a congenital heart defect or history of endocarditis. Less serious conditions may cause similar signs and symptoms. A proper evaluation by a health care provider is needed to make the diagnosis.
If you've been diagnosed with endocarditis and have any of the following symptoms, tell your care provider. These symptoms may mean the infection is getting worse:
Endocarditis is usually caused by an infection with bacteria, fungi or other germs. The germs enter the bloodstream and travel to the heart. In the heart, they attach to damaged heart valves or damaged heart tissue.
Usually, the body's immune system destroys any harmful bacteria that enter the bloodstream. However, bacteria on the skin or in the mouth, throat or gut (intestines) may enter the bloodstream and cause endocarditis under the right circumstances.
Many different things can cause germs to get into the bloodstream and lead to endocarditis. Having a faulty, diseased or damaged heart valve increases the risk of the condition. However, endocarditis may occur in those without heart valve problems.
Risk factors for endocarditis include:
If you're at risk of endocarditis, tell your health care providers. 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 website.
A typical heart has two upper and two lower chambers. The upper chambers — the right and left atria — receive incoming blood. The lower chambers — the right and left ventricles — pump blood out of your heart. The heart valves, which keep blood flowing in the right direction, are gates at the chamber openings (for the tricuspid and mitral valves) and exits (for the pulmonary and aortic valves).
In endocarditis, irregular growths made of germs and cell pieces form a mass in the heart. These clumps are called vegetations. They can break loose and travel to the brain, lungs, kidneys and other organs. They can also travel to the arms and legs.
Complications of endocarditis may include:
You can take the following steps to help prevent endocarditis:
Certain dental and medical procedures may allow bacteria to enter your bloodstream.
If you're at high risk of endocarditis, the American Heart Association recommends taking antibiotics an hour before having any dental work done.
You're at high risk of endocarditis and need antibiotics before dental work if you have:
If you have endocarditis or any type of congenital heart disease, talk to your dentist and other care providers about your risks and whether you need preventive antibiotics.
To diagnose endocarditis, a health care provider does a physical exam and asks questions about your medical history and symptoms. Tests are done to help confirm or rule out endocarditis.
Tests used to help diagnose endocarditis include:
Echocardiogram. Sound waves are used to create images of the beating heart. This test shows how well the heart's chambers and valves pump blood. It can also show the heart's structure. Your provider may use two different types of echocardiograms to help diagnose endocarditis.
In a standard (transthoracic) echocardiogram, a wandlike device (transducer) is moved over the chest area. The device directs sound waves at the heart and records them as they bounce back.
In a transesophageal echocardiogram, a flexible tube containing a transducer is guided down the throat and into the tube connecting the mouth to the stomach (esophagus). A transesophageal echocardiogram provides much more detailed pictures of the heart than is possible with a standard echocardiogram.
Many people with endocarditis are successfully treated with antibiotics. Sometimes, surgery may be needed to fix or replace damaged heart valves and clean up any remaining signs of the infection.
The type of medication you receive depends on what's causing the endocarditis.
High doses of IV antibiotics are used to treat endocarditis caused by bacteria. If you receive IV antibiotics, you'll generally spend a week or more in the hospital so that care providers can determine if the treatment is working.
Once your fever and any severe symptoms have gone away, you might be able to leave the hospital. Some people continue IV antibiotics with visits to a provider's office or at home with home care. Antibiotics are usually taken for several weeks.
If endocarditis is caused by a fungal infection, antifungal medication is given. Some people need lifelong antifungal pills to prevent endocarditis from returning.
Heart valve surgery may be needed to treat persistent endocarditis infections or to replace a damaged valve. Surgery is sometimes needed to treat endocarditis that's caused by a fungal infection.
Depending on your specific condition, your health care provider may recommend heart valve repair or replacement. Heart valve replacement uses a mechanical valve or a valve made from cow, pig or human heart tissue (biologic tissue valve).
The first health care provider you see will likely be your primary care provider or an emergency room doctor. You may be referred to a doctor or surgeon trained in diagnosing and treating heart conditions (cardiologist).
You can help prepare for your appointment by taking these steps:
It's also important to write down any questions you might have before you get to your appointment. For endocarditis, some basic questions you might want to ask your health care provider include:
Your health care provider will probably ask you many questions, including: