Reviewed by Brian R. Robinson, MD Endocarditis is an infection of the endocardium, the inner lining of the heart and heart valves. It affects the valves first, but can spread to other areas of the body. It can be treated with antibiotics, but if untreated can lead to serious complications.
Endocarditis usually occurs in someone with a pre-existing heart condition, and is usually caused by bacteria. This underlying condition makes the heart susceptible to infection. The source of the bacteria is often unknown, but it can result from dental or other medical procedures. People with pre-existing heart conditions therefore need to be careful when undergoing such procedures, and may need to take antibiotics before even routine dental cleanings to reduce the risk of infection.
When the bacteria spreads to the heart, it can lodge in the valves and eat away at the tissue. The bacteria can also cause growths, which can potentially dislodge and act as a blood clot. This can lead to a stroke, or, if the clot travels to the kidney and liver, complications with those organs. The infection may damage the heart alone or spread to other parts of the body. If not treated properly, the bacteria can damage the heart enough to cause serious heart valve disease or heart failure.
Previous heart conditions that increase risk of endocarditis include:
Sources of bacterial infection include:
- Teeth cleaning
- Tonsillectomy or adenoidectomy
- Bronchoscopy
- Gall bladder or prostate surgery
Early symptoms include:
- Fever, including sweats, fatigue, muscle aches and chills
- Heart murmur
- Loss of appetite
If the infection gets more serious, it can cause fluid to back up in the lungs, which can cause shortness of breath. If it spreads to the kidneys, the patient may see blood in his or her urine. If it spreads to the brain, it can cause headaches, confusion, and ultimately, stroke.
The doctor may suspect endocarditis if the patient expresses the symptoms and has a history of heart disease. An enlarged spleen or hemorrhages in the eyes or under the nails also indicate endocarditis. An examination with a stethoscope may reveal a heart murmur or a change in an existing heart murmur. If the doctor discovers some of these signs, he or she may order a variety of non-invasive diagnostics, or the more invasive transesophageal echocardiogram to confirm the diagnosis.
Endocarditis without more serious complications is treated with antibiotics. Through blood tests, the doctor will determine the bacteria causing the infection so he or she can prescribe the proper medication. The patient may have to take high doses of the medication, often through an IV, for six weeks or more, and activity will be restricted until improvement is seen. If the antibiotics do not cure the infection, open heart surgery may be warranted to remove the infected valve. The procedure for this surgery would be similar to that for a heart valve replacement.
