Definition

Endocarditis is an inflammatory condition that affects the surface of the heart valves and, in some cases, the inner lining of the heart ventricles. This condition develops when germs (typically bacteria) from other parts of your body enter your bloodstream, attach to, and attack the valve surfaces and/or inner lining of your heart ventricles. The inner lining of the heart and its valve surfaces are called the endocardium.

When inflammation of the endocardium is caused by an infection, this condition is called infective endocarditis. If the infection is not treated with antibiotics or surgery, it can lead to permanent heart damage and even death. Endocarditis rarely occurs in people with a healthy heart. People most at risk of developing endocarditis usually have damaged heart valves, artificial heart valves, or other heart defects.

Endocarditis is twice as common in men as in women. In the United States, people aged 60 and up account for more than 25% of all endocarditis cases. According to research, endocarditis affects at least 4 out of every 100,000 people each year, and the number continues to rise.

Causes

Endocarditis can develop when bacteria or fungi enter the body through an infection or when normally harmless bacteria from the mouth, upper respiratory tract, or other parts of the body invade heart tissue. Under normal circumstances, the immune system can usually destroy these unwanted microorganisms, but if the heart valves are damaged, they can attach to the heart and multiply.

A clot of bacteria and cells will form on the heart valve. These clots make it difficult for the heart to function normally. They can cause abscesses (pus-filled pockets) in the heart muscle and valves, as well as tissue damage and electrical conduction abnormalities. Clots can sometimes break off and spread to other parts of the body, including the kidneys, lungs, and brain.

Some causes of endocarditis may include:

• Dental problems or procedures that can lead to infection. Poor dental or gum health will also increase the risk of endocarditis, as bacteria can more easily enter the bloodstream. Good dental hygiene can help prevent heart infections
• Other surgical procedures can allow bacteria to enter, including digestive tract tests like a colonoscopy. Procedures affecting the respiratory tract, urinary tract (including the kidneys, bladder, and urinary tract), skin, bones, and muscles are all risk factors
• Heart abnormalities can increase the risk of developing endocarditis if bacteria enter the body. These can include birth defects, abnormal heart valves, or damaged heart tissue. People with artificial heart valves also have a higher risk
• Bacterial infections in other parts of the body, such as a skin sore or gum disease, can cause the bacteria to spread
• Sexually transmitted infections (STIs), such as chlamydia or gonorrhea, make it easier for bacteria to enter the body and enter the heart
• Candida yeast infection can cause endocarditis
• Inflammatory bowel disease (IBD) or any bowel disorder can also increase the risk, but the risk of someone with IBD developing endocarditis is still low
• Surgical or medical devices used in treatment, such as urinary catheters or long-term injected medicines, may also increase the risk

Risk Factor

Factors that may increase the risk of developing endocarditis include:

• Advanced age. Endocarditis is most common in older adults over the age of 60
• Having an artificial heart valve. Germs are more likely to stick to artificial (prosthetic) heart valves than normal heart valves
• Damaged heart valves. Certain medical conditions, such as rheumatic fever or infections, can damage or injure one or more of your heart valves, increasing your risk of infection
• Congenital heart defects. If you were born with certain heart defects, such as abnormal heart valves, your heart may be more susceptible to infection
• Implanted heart devices. Bacteria can attach to implanted devices, such as pacemakers, causing infections in the lining of the heart
• History of endocarditis. Endocarditis can damage heart tissue and valves, increasing the risk of future heart infections
• History of illegal injection drug use. People who use illegal drugs by injection have a greater risk of developing endocarditis. The needles used to inject the drugs can be contaminated with endocarditis-causing bacteria
• Poor dental health. A healthy mouth and healthy gums are essential for good health. If you don't brush and floss regularly, bacteria can grow inside your mouth and enter the bloodstream through sores on your gums
• Long-term catheter use. Having a catheter in place for a long period of time (indwelling catheter) increases the risk of endocarditis
• Weakened immune system

Symptoms

Endocarditis may develop slowly or suddenly, depending on the germ causing the infection and whether you have any underlying heart conditions. Endocarditis symptoms vary from person to person. Common symptoms of endocarditis include:

• Joint and muscle pain
• Chest pain when breathing
• Fatigue
• Flu-like symptoms, such as fever and chills
• Night sweats
• Shortness of breath
• Swelling in your feet, legs or abdomen
• Heart noise, which is a heart sound made by blood flowing through your heart

Less common signs and symptoms of endocarditis may include:

• Unexplained weight loss
• Blood in your urine
• Pressure pain in your spleen, which is an infection-fighting organ located just below your left rib cage
• Red spots on the soles of your feet or palms of your hands (Janeway lesions)
• Red, soft spots under the skin of your fingers or toes (Osler nodes)
• Small purple or red spots, called petechia, on the skin, whites of the eyes or inside of the mouth

Diagnosis

When diagnosing endocarditis, your doctor will first conduct an interview with you, asking about your symptoms, how long you have had them, and any risk factors that may have contributed to the onset of the condition. Next, the doctor will perform a physical examination. The doctor will use a stethoscope to listen to your heartbeat. Other supporting examinations used to diagnose endocarditis may include:

• Blood culture to pinpoint the bacteria or microorganisms causing endocarditis. To confirm the diagnosis, the lab should take a blood culture before you start taking antibiotics
• A complete blood count can inform the doctor if you have a very high white blood cell count, which could mean you may have an infection
• C-reactive protein blood test, which can show that you have inflammation
• Echocardiogram, which may show images of the state of the heart valves and inner lining of the heart
• Positron emission tomography (PET) or nuclear medicine scan to create images using radioactive material that can show the location of the infection

Management

Endocarditis treatment and therapy may include:

• Antibiotics

If your endocarditis is caused by bacteria, it will be treated with antibiotic therapy. You may receive this treatment in the hospital for at least a week until you show signs of improvement and will need to continue antibiotic therapy after discharge. Antibiotic therapy usually takes up to six weeks to complete

• Surgery

Prolonged endocarditis or heart valve damage caused by endocarditis may require surgery to repair. Surgery may be performed to remove dead tissue, scar tissue, fluid buildup, or debris from infected tissue. Surgery may also be performed to repair or remove your damaged heart valves and replace them with artificial materials

Complications

In endocarditis, clots formed by germs and heaps of cells create an abnormal mass in your heart. These clumps, called vegetations, can break off and spread to your brain, lungs, abdominal organs, kidneys, or arms and legs. As a result, endocarditis can lead to several complications, including:

• Heart disorders, such as heart valve damage and heart failure
• Stroke
• Collected pus pockets (abscesses) that develop in the heart, brain, lungs, and other organs
• Blood clots in the arteries of the lungs (pulmonary embolism)
• Kidney damage
• Enlargement of the spleen

Prevention

You can take the following steps to help prevent endocarditis:

• Recognize the symptoms of endocarditis. See your doctor immediately if you experience any symptoms, especially a fever that doesn't go away, unexplained fatigue, any type of skin infection, or open wounds or cuts that don't heal properly
• Take care of your teeth and gums. Brush and floss your teeth and gums frequently, and have regular dental check-ups. Good dental hygiene is an important part of maintaining your overall health
• Do not use illegal injection drugs. Dirty needles can spread bacteria into your bloodstream, increasing your risk of endocarditis

When to See a Doctor?

Consult with a doctor immediately if you experience symptoms that point to endocarditis.

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