img-endocaritis-01 EndocarditisEndocarditis

Endocarditis (EN-do-kar-DI-tis) is an infection of the inner lining of your heart chambers and valves. This lining is called the endocardium. The condition also is called infective endocarditis (IE).

The term "endocarditis" also is used to describe an inflammation of the endocardium due to other conditions. This article only discusses endocarditis related to infection.

IE occurs if bacteria, fungi, or other germs invade your bloodstream and attach to abnormal areas of your heart. The infection can damage the heart and cause serious and sometimes fatal complications.

IE can develop quickly or slowly. How the infection develops depends on what type of germ is causing it and whether you have an underlying heart problem. When IE develops quickly, it's called acute infective endocarditis. When it develops slowly, it's called subacute infective endocarditis.

Overview of Endocarditis

IE mainly affects people who have:

  • Damaged or artificial heart valves
  • Congenital heart defects (defects present at birth)
  • Implanted medical devices in the heart or blood vessels

People who have normal heart valves also can get IE. However, the condition is much more common in people who have abnormal hearts.

Certain factors make it easier for bacteria to enter your bloodstream. These factors also put you at higher risk for the infection. For example, if you've had IE before, you're at higher risk for the infection.

Other risk factors include having poor dental hygiene and unhealthy teeth and gums, using intravenous (IV) drugs, and having catheters or other medical devices in your body for long periods.

Common symptoms of IE are fever and other flu-like symptoms. Because the infection can affect people in different ways, the signs and symptoms vary. IE also can cause complications in many other parts of the body besides the heart.

If you're at high risk for IE, seek medical care if you have signs or symptoms of the infection, especially a fever that persists or unexplained fatigue (tiredness).

Outlook

IE is treated with antibiotics for several weeks. You also may need heart surgery to repair or replace heart valves or remove infected heart tissue.

Most people who are treated with the proper antibiotics recover. But if the infection isn't treated, or if it persists despite treatment (for example, if the bacteria are resistant to antibiotics), it's usually fatal.

If you have signs or symptoms of IE, you should see your doctor as soon as you can, especially if you have abnormal heart valves.

Signs and Symptoms

Infective endocarditis (IE) can cause a range of signs and symptoms that can vary from person to person. Signs and symptoms also can vary over time in the same person.

Signs and symptoms differ depending on whether you have an underlying heart problem, the type of germ causing the infection, and whether you have acute or subacute IE.

Signs and symptoms of IE may include:

  • Flu-like symptoms, such as fever, chills, fatigue (tiredness), aching muscles and joints, night sweats, and headache.
  • Shortness of breath or a cough that won't go away.
  • A new heart murmur or a change in an existing heart murmur.
  • Skin changes such as:
    • Overall paleness.
    • Small, painful, red or purplish bumps under the skin on the fingers or toes.
    • Small, dark, painless, flat spots on the palms of the hands or the soles of the feet.
    • Tiny spots under the fingernails, on the whites of the eyes, on the roof of the mouth and inside of the cheeks, or on the chest. These spots are from broken blood vessels.
  • Nausea (feeling sick to your stomach), vomiting, a decrease in appetite, a sense of fullness with discomfort on the upper left side of the abdomen, or weight loss with or without a change in appetite.
  • Blood in the urine.
  • Swelling in the feet, legs, or abdomen.

Diagnosis

Your doctor will diagnose infective endocarditis (IE) based on your risk factors, your medical history and signs and symptoms, and the results from tests.

Diagnosis of the infection often is based on a number of factors, rather than a single positive test result, sign, or symptom.

Diagnostic Tests

The results from blood tests, echocardiography, and an EKG (electrocardiogram) can help diagnose IE.

Blood Tests

Blood cultures are the most important blood tests used to diagnose IE. Blood is drawn several times over a 24-hour period. It's put in special culture bottles that allow bacteria to grow.

Doctors then identify and test the bacteria to see which antibiotics will kill them. Sometimes the blood cultures don't grow any bacteria, but the person still has IE. This is called culture-negative endocarditis, and it requires antibiotic treatment.

More standard blood tests also are used to diagnose IE. For example, a complete blood count may be used to check the number of red and white blood cells in your blood. Blood tests also may be used to check your immune system and to check for inflammation.

Echocardiography

Echocardiography is a painless test that uses sound waves to create pictures of your heart. Two types of echocardiography are useful in diagnosing IE.

Transthoracic (tranz-thor-AS-ik) echocardiogram. For this painless test, gel is applied to the skin on your chest. A device called a transducer is moved around on the outside of your chest.

This device sends sound waves called ultrasound through your chest. As the ultrasound waves bounce off the structures of your heart, a computer converts them into pictures on a screen.

Your doctor uses the pictures to look for vegetations, areas of infected tissue (such as an abscess), and signs of heart damage.

Because the sound waves have to pass through skin, muscle, tissue, bone, and lungs, the pictures may not have enough detail. Thus, your doctor may recommend a transesophageal (tranz-ih-sof-uh-JEE-ul) echocardiogram (TEE).

Transesophageal echocardiogram

For this test, a much smaller transducer is attached to the end of a long, narrow, flexible tube. The tube is passed down your throat. Before the procedure, you're given medicine to help you relax, and your throat is sprayed with numbing medicine.

The doctor then passes the transducer down your esophagus (the passage from your mouth to your stomach). Because this passage is right behind the heart, the transducer can get clear pictures of the heart's structures.

EKG

An EKG is a simple, painless test that detects heart's electrical activity. It shows how fast your heart is beating, whether your heart rhythm is steady or irregular, and the strength and timing of electrical signals as they pass through your heart.

An EKG typically isn't used to diagnose IE. However, it may be done to see whether IE is affecting your heart's electrical activity.

For this test, soft, sticky patches called electrodes are attached to your chest, arms, and legs. You lie still while the electrodes detect your heart's electrical signals. A machine records these signals on graph paper or shows them on a computer screen. The entire test usually takes about 10 minutes.

Treatment

Infective endocarditis (IE) is treated with antibiotics and sometimes with heart surgery.

Antibiotics

Antibiotics usually are given for 2 to 6 weeks through an intravenous (IV) line inserted into a vein. You're often hospitalized for at least the first week or more of treatment. This allows your doctor to make sure your infection is responding to the antibiotics.

If you're allowed to go home before the treatment is done, the antibiotics are almost always continued by vein at home. You'll need special care if you get IV antibiotic treatment at home. Before you leave the hospital, your medical team will arrange for you to receive home-based care so you can continue your treatment.

You also will need close medical follow up, usually by a team of doctors. This team often includes a doctor who specializes in infectious diseases, a cardiologist (heart specialist), and a heart surgeon.

Surgery

In some cases, surgery is needed to repair or replace a damaged heart valve or to help clear up the infection. IE due to an infection with fungi often requires surgery. This is because this type of IE is harder to treat than IE due to bacteria.