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an infection of the heart's valves or its inner lining (endocardium). It is
most common in people who have a damaged, diseased, or artificial heart
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Endocarditis is caused
by bacteria (or in rare cases, by fungi) that enter the bloodstream and settle on the
inside of the heart, usually on the heart valves. Bacteria can invade your
bloodstream in many ways, including during some dental and surgical procedures.
If you don't take care of your teeth, having your teeth cleaned or even
brushing your teeth can cause bacteria to enter the bloodstream.
have a normal heart, you have a low risk for endocarditis. But if
you have a problem with your heart that affects normal blood flow through the heart, it is more
likely that bacteria or fungi will attach to heart tissue. This puts you at a
higher risk for endocarditis.
You have a higher risk of endocarditis if you have:
Not all heart problems give you a higher risk of endocarditis. You do not have a higher risk
if you have:
If you have certain heart conditions, getting endocarditis is even more
dangerous for you. These heart conditions include:
If you have any of these heart conditions, you may need
to take antibiotics before you have certain dental and surgical procedures. The
antibiotics lower your risk of getting endocarditis. If you do not have these conditions, antibiotics are not likely to help you.
Procedures that may require antibiotics include:
Practicing good oral hygiene is especially important to
prevent endocarditis if you are at risk.
Your doctor can give you
a card to carry in your wallet. The card states that you may need preventive
antibiotics before certain procedures.
The symptoms of
endocarditis progress as the bacteria or fungi grow in your heart. Vague,
flu-like symptoms, such as a low-grade fever and fatigue, often occur first.
Most people with endocarditis begin to have symptoms within 2 weeks after
becoming infected with bacteria or fungi.
But a powerful strain of
bacteria may cause symptoms to appear much faster, within a few days.
Although symptoms are vague and may not seem worth
telling your doctor about, if they don't go away or if you know you are at risk
for endocarditis, contact your doctor.
If endocarditis is not
treated, the bacteria that cause endocarditis can form growths on or around the
heart valves. The growths prevent the heart valves from opening and closing
properly. This interrupts the normal blood flow through the valves and
interferes with the heart's pumping action. Blood can leak backwards instead of
being pumped forward. Over time,
heart failure can develop, because your heart may not
be able to pump enough blood to meet your body's needs.
Endocarditis can also cause other problems, including:
First your doctor
will ask about your medical history and do a physical exam. If your doctor
thinks that you may have endocarditis, he or she will check for signs of the
infection, such as a
heart murmur, an enlarged spleen, skin rashes, and
bleeding under your nails.
will be done to check for bacteria in your bloodstream. And other tests, such
echocardiogram, may be done to check your heart
function and look at your heart valves.
It is important to treat
endocarditis as soon as possible to avoid permanent damage to the heart muscle
or heart valves.
Antibiotics given through a
vein (intravenously, or by IV) are the usual treatment for endocarditis. If
your heart valves are damaged by the infection or if you have an artificial
heart valve, surgery to repair or replace the valve may be needed. You may also
need surgery if your endocarditis is caused by a fungus. If it is not treated,
endocarditis can be fatal.
Frequently Asked Questions
Learning about endocarditis:
Living with endocarditis:
Most people with
endocarditis have symptoms that begin within 2 weeks
after becoming infected. Vague, flu-like symptoms, such as a low-grade fever
and fatigue, often occur first. But infection with a powerful strain of
bacteria may cause symptoms to be more severe (such as a high fever) and to
appear much faster, within a few days. If symptoms persist, see your doctor,
especially if you are at a high risk for endocarditis.
If you have certain heart conditions, getting endocarditis
is even more dangerous for you. These heart conditions include:
Other risk factors (things that raise your risk) for endocarditis include:
Your doctor can tell you whether you are at
increased risk for endocarditis. Before you
have any medical, dental, or surgical procedures, tell all other health
professionals who may treat you that you are at risk for endocarditis. Your doctor can give you a
card to carry in your wallet stating that you may need preventive
antibiotics before having certain procedures.
You will likely have symptoms if you have a complication of endocarditis. Complications may include:
The first step in diagnosing
endocarditis is a review of your medical history and a
As part of your medical history, your doctor will
As part of your physical exam, your doctor will check your body for signs of an infection. This includes:
Other tests may be needed to diagnose endocarditis. They
You may need other tests to identify
complications of endocarditis. These tests may
There are three main goals when
Destroy the infection
If you have endocarditis, you will need several weeks of treatment with
one or more antibiotics. At first you will be treated in the hospital, because
the antibiotics are given through a vein (by IV) and you
may need other tests during treatment. After your fever is gone and you are
stable, you may be able to continue IV antibiotics at home with the help of a
home health nurse.
Antibiotics are usually given for 4 to 8
weeks, but some people may require only 2 to 4 weeks of treatment. How long you
take antibiotics may depend on what type of bacteria is causing the infection
or whether you have an infection of artificial heart valves. For example, you
may take antibiotics for a longer time because you have artificial heart
valves. The antibiotics must be given long enough and at a strong enough dose
to destroy all of the bacteria.
After the first IV antibiotics,
your doctor may want you to take antibiotic pills. If so, take them exactly as
prescribed until they are gone. If your symptoms return, call your doctor right
away. You probably will need more antibiotics if testing shows that the
bacteria were not completely destroyed.
If endocarditis is caused
by a fungus, you may need intravenous antifungal medicine. And heart valve
surgery usually is required for endocarditis caused by a fungus.
If your heart valve becomes
severely damaged from
endocarditis or if infection develops in an artificial
heart valve, you may need surgery to repair or replace the valve.
You may need surgery if you have:
Your medical team
Treatment for endocarditis is usually guided by an
infectious disease specialist. A
cardiologist may also be involved if your heart muscle
or valves are damaged. You will need a
cardiovascular surgeon if you have heart valve
After your condition has stabilized,
you can probably go home where you may continue to receive antibiotic treatment. You may have a central venous catheter, such as a PICC line, that gives you antibiotics into a vein. A home health nurse will help with these medicines. The
nurse will teach you how to give yourself the antibiotics and how to
care for your catheter.
Be sure to tell your doctor if
symptoms, such as a fever or chills, return or if you have any new
If you have a normal heart
and valve structure, you have a low risk for endocarditis. But if
you have a problem with your heart that affects normal blood flow, it increases
the likelihood that bacteria or fungi will attach to heart tissue. This puts
you at a higher risk for endocarditis.
If you have certain heart
conditions, getting endocarditis is even more dangerous for you. These heart
If you have any of these heart conditions, you may need
to take antibiotics before you have certain
dental or surgical procedures that could put bacteria
or fungi into your blood. The antibiotics lower your risk of getting
Your doctor can give you a card to carry in your
wallet. It states that you may need preventive antibiotics before certain
If you are at increased risk for endocarditis,
practice good oral hygiene. Floss your teeth daily, and visit a dentist twice
each year. For more information, see the topic
Also, if you have conditions such as an HIV infection that
weaken your ability to fight disease, you are at greater risk.
Visit the American Heart Association (AHA) website for information on
physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your
nearest local or state AHA group. The AHA provides brochures and information
about support groups and community programs, including Mended Hearts, a
nationwide organization whose members visit people with heart problems and
provide information and support.
The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
Other Works ConsultedBaddour LM, et al. (2005). Infective endocarditis: Diagnosis, antimicrobial therapy, and management of complications: A statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart ABonow RO, et al. (2008). 2008 Focused update incorporated into the ACC/AHA 2006 Guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing committee to revise the 1998 Guidelines for the management of patients with valvular heart disease). Circulation, 118(15):Endocarditis prophylaxis for dental procedures (2012). The Medical Letter on Drugs and Therapeutics, 54(1339): 74. [Erratum in Medical Letter on Drugs and Therapeutics, 54(1401): 84].Haldar SM, O'Gara PT (2011). Infective endocarditis. In V Fuster et al., eds., Hurst's the Heart, 13th ed., vol. 2, pp. 1940–1969. New York: McGraw-Hill.Karchmer AW, Bonow RO (2012). Infective endocarditis. In RO Bonow et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 2, pp. 1540–1558. Philadelphia: Saunders.Li JS, et al. (2007). Infective endocarditis. In EJ Topol et al., eds., Textbook of Cardiovascular Medicine, 8th ed., pp. 402–419. Philadelphia: Lippincott Williams and Wilkins.Wilson W, et al. (2007). Prevention of endocarditis. Guidelines from the American Heart Association. A guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Res
March 9, 2011
E. Gregory Thompson, MD - Internal Medicine & W. David Colby IV, MSc, MD, FRCPC - Infectious Disease
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