Definition

Endocarditis is inflammation of the inside lining of the heart chambers and heart valves (endocardium).

See also:

• Culture-negative endocarditis
• Infective endocarditis

Alternative Names

Causes, incidence, and risk factors

Endocarditis can involve the heart muscle, heart valves, or lining of the heart. Most people who develop endocarditis have heart disease of the valves.

Risk factors for developing endocarditis include:

• Injection drug use
• Permanent central venous access lines
• Prior valve surgery
• Recent dental surgery
• Weakened valves

Bacterial infection is the most common source of endocarditis. However, it can also be caused by fungi. In some cases, no cause can be identified.

Symptoms

• Abnormal urine color
• Blood in the urine
• Chills
• Excessive sweating
• Fatigue
• Fever
• Heart murmur
• Joint pain
• Muscle aches and pains
• Night sweats
• Nail abnormalities (splinter hemorrhages under the nails)
• Paleness
• Red, painless skin spots on the palms and soles (Janeway lesions)
• Red, painful nodes in the pads of the fingers and toes (Osler's nodes)
• Shortness of breath with activity
• Swelling of feet, legs, abdomen
• Weakness
• Weight loss

Note: Endocarditis symptoms can develop slowly (subacute) or suddenly (acute).

Signs and tests

Doctors might suspect endocarditis in people with a history of:

• Congenital heart disease
• Intravenous drug use
• Recent dental work
• Rheumatic fever

Physical examination may reveal an enlarged spleen.

The health care provider may detect a new heart murmur, or a change in a previous heart murmur. Examination of the nails may show splinter hemorrhages.

Eye examination may show retinal hemorrhages with a central area of clearing (called Roth's spots), and small, pinpoint hemorrhages (petechiae) in the conjunctiva. The fingertips may become enlarged and the nails may curve (clubbing).

Tests:

• CBCanemia
• Chest x-ray
• Echocardiogram
• ECG
• Erythrocyte sedimentation rate (ESR)
• Repeated blood culture and sensitivity
• Serology
• Transesophageal echocardiogram

Treatment

People with this condition will often need to be hospitalized at first to receive antibiotics through a vein (intravenously). Long-term antibiotic therapy is needed to get the bacteria out of the heart chambers and valves.

Patients will usually have therapy for 6 weeks. The antibiotic must be specific for the organism causing the condition. This is determined by the blood culture and the sensitivity tests.

Surgery to replace the heart valve is usually needed when:

• The infection is breaking off in little pieces, resulting in a series of strokes
• The person develops heart failure as a result of damaged heart valves
• There is evidence of organ damage

Support Groups

Expectations (prognosis)

Early treatment of endocarditis improves the chances of a good outcome. However, valve destruction or strokes can result in death.

Complications

• Arrhythmias, such as atrial fibrillation
• Blood clots or an infected clot from the endocarditis that travels to the brain, kidneys, lungs, or abdomen, causing severe damage to, and infection of, these organs
• Brain abscess
• Brain or nervous system changes
• Congestive heart failure
• Glomerulonephritis
• Jaundice
• Severe heart valve damage
• Stroke

Calling your health care provider

Call your health care provider if you notice the following symptoms during or after treatment:

• Blood in urine
• Chest pain
• Fatigue
• Fever
• Numbness
• Weakness
• Weight loss without change in diet

Prevention

People with certain heart conditions often take preventive antibiotics before dental procedures or surgeries involving the respiratory, urinary, or intestinal tract. Those with a history of endocarditis should have continued medical follow-up.

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