What is endocarditis?
Endocarditis is an infection of the endocardium, which is the inner lining of your heart chambers and heart valves.
How common is endocarditis?
Endocarditis is quite rare. Please discuss with your doctor for further information.
What are the symptoms of endocarditis?
The common symptoms of endocarditis are:
- Flu-like symptoms, such as fever and chills
- A new or changed heart murmur, which is the heart sounds made by blood rushing through your heart
- Aching joints and muscles
- Night sweats
- Shortness of breath
- Chest pain when you breathe
- Swelling in your feet, legs or abdomen
Endocarditis can also cause symptoms that are more uncommon. These include:
- Unexplained weight loss
- Blood in your urine, which you might be able to see or that your doctor might see when he or she views your urine under a microscope
- Tenderness in your spleen, which is an infection-fighting abdominal organ just below your rib cage on the left side of your body
- Janeway lesions, which are red spots on the soles of your feet or the palms of your hands
- Osler’s nodes, which are red, tender spots under the skin of your fingers or toes
- Petechiae, which are tiny purple or red spots on the skin, whites of your eyes, or inside your mouth
Endocarditis may develop slowly or suddenly, depending on what germs are causing the infection and whether you have any underlying heart problems. Endocarditis signs and symptoms can vary from person to person.
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.
What causes endocarditis?
Endocarditis occurs when germs enter your bloodstream, travel to your heart, and attach to abnormal heart valves or damaged heart tissue. Certain types of bacteria cause most cases, but fungi or other microorganisms also may be responsible.
Usually, your immune system destroys harmful bacteria that make it into your bloodstream. Even if bacteria reach your heart, they may pass through without causing an infection. However, bacteria that live in your mouth, throat or other parts of your body, such as your skin or your gut, can sometimes cause serious infections like endocarditis under the right circumstances.
Bacteria, fungi or other germs that cause endocarditis might enter your bloodstream through:
- Everyday oral activities. Activities such as brushing your teeth, or other activities that could cause your gums to bleed, can allow bacteria to enter your bloodstream — especially if you don’t floss or your teeth and gums aren’t healthy.
- An infection or other medical condition. Bacteria may spread from an infected area, such as a skin sore. Other medical conditions, such as gum disease, a sexually transmitted infection or certain intestinal disorders — such as inflammatory bowel disease — can also give bacteria the opportunity to enter your bloodstream.
- Bacteria can enter your body through a catheter — a thin tube that doctors sometimes use to inject or remove fluid from the body. This is more likely to occur if the catheter is in place for a long period of time.
- Needles used for tattoos and body piercing. The bacteria that can cause endocarditis can also enter your bloodstream through the needles used for tattooing or body piercing.
- Intravenous (IV) illegal drug use. Contaminated needles and syringes are a special concern for people who use illegal intravenous (IV) drugs, such as heroin or cocaine. Often, individuals who use these types of drugs don’t have access to clean, unused needles or syringes.
- Certain dental procedures. Some dental procedures that can cut your gums may allow bacteria to enter your bloodstream.
Bacteria can more easily attach to the lining of your heart (endocardium), if the lining’s surface is rough. You’re also more likely to develop endocarditis if you have faulty, diseased or damaged heart valves. However, endocarditis does occasionally occur in previously healthy individuals.
What increases my risk for endocarditis?
There are many risk factors for endocarditis, such as:
- Artificial heart valves. Germs are more likely to attach to an artificial (prosthetic) heart valve than to a normal heart valve.
- Congenital heart defects. If you were born with certain types of heart defects, such as an irregular heart or abnormal heart valves, your heart may be more susceptible to infection.
- A history of endocarditis. Endocarditis can damage heart tissue and valves, increasing the risk of a future heart infection.
- Damaged heart valves. Certain medical conditions, such as rheumatic fever or infection, can damage or scar one or more of your heart valves. This can make them more prone to endocarditis.
- A history of intravenous (IV) illegal drug use. People who use illegal drugs by injecting them are at a greater risk of endocarditis. The needles used to inject drugs can be contaminated with the bacteria that can cause endocarditis.
If your heart is healthy, you could be less likely to develop endocarditis, although it is still possible. The germs that cause infection tend to stick to and multiply on damaged or surgically implanted heart valves, or on endocardium that has a rough surface.
Diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is endocarditis diagnosed?
Your doctor may suspect endocarditis based on your medical history, signs and symptoms you’re experiencing, and your test results. A diagnosis of endocarditis is usually based on several factors instead of a single positive test result or symptom.
Your doctor may order several tests to help make a positive diagnosis, including:
- Blood tests. A blood culture test is used to identify any bacteria or fungi in your bloodstream, and it’s the most important test your doctor will perform. Blood tests can also help your doctor identify certain conditions that can be a sign of endocarditis, such as anemia — a shortage of healthy red blood cells.
- An echocardiogram uses sound waves to produce images of your heart while it’s beating. This test is often used to check for signs of infection. Your doctor may use two different types of echocardiograms to help diagnose endocarditis. In a transthoracic echocardiogram, sound waves directed at your heart from a wandlike device (transducer) held on your chest produce video images of your heart in motion. This test can help your doctor look at your heart’s structure and check it for any signs of infection or damage. Doctors may conduct another type of echocardiogram called a transesophogeal echocardiogram to get a closer look at your heart valves. During this test, a small transducer attached to the end of a tube is inserted down the tube leading from your mouth to your stomach (esophagus). This test can allow your doctor to get much more detailed pictures of your heart than is possible with a transthoracic echocardiogram.
- Electrocardiogram (ECG). While an ECG isn’t specifically used to diagnose endocarditis, it can show your doctor if something is affecting your heart’s electrical activity. During an ECG, sensors that can detect your heart’s electrical activity are attached to your chest, arms and legs. This test is used to measure the timing and duration of each electrical phase in your heartbeat.
- Chest X-ray. X-ray images help your doctor see the condition of your lungs and heart. Your doctor can use X-ray images to see if endocarditis has caused your heart to enlarge or if any infection has spread to your lungs.
- Computerized tomography (CT) scan or magnetic resonance imaging (MRI). You may need a CT scan or an MRI scan of your brain, chest or other parts of your body if your doctor thinks that infection has spread to these areas.
How is endocarditis treated?
Many cases of endocarditis are successfully treated with antibiotics. Sometimes, surgery may be required to fix damaged heart valves and clean up any remaining signs of the infection.
If you have endocarditis, your doctor might recommend high doses of intravenous (IV) antibiotics in the hospital. Your doctor will use blood culture tests to help identify the organism that’s causing your infection. Based on the results of your blood tests, your doctor will choose the most appropriate antibiotic or combination of antibiotics to fight the infection.
You’ll generally spend a week or more in the hospital when you start taking IV antibiotics. This gives your doctor time to see if the antibiotics are working against your infection. You’ll usually take antibiotics for several weeks to clear up the infection.
Once your fever and the worst of your signs and symptoms have passed, you might be able to leave the hospital and continue IV antibiotic therapy with visits to your doctor’s office or at home with home-based care. You’ll still need to see your doctor regularly to make sure your treatment is working.
It’s important to tell your doctor about any signs or symptoms that may mean your infection is getting worse, such as:
- Joint pain
- Shortness of breath
Also, if you develop diarrhea, a rash, itching or joint pain, let your doctor know as soon as possible. These signs and symptoms may indicate you’re having a reaction to your prescribed antibiotic.
If you have shortness of breath or swelling in your legs, ankles or feet after you start antibiotic treatment, see your doctor immediately. These signs and symptoms can be indicators of heart failure.
If the infection damages your heart valves, you may have symptoms and complications for years after treatment. Sometimes surgery is needed to treat persistent infections or to replace a damaged valve. Surgery is also sometimes needed to treat endocarditis that’s caused by a fungal infection.
Depending on your condition, your doctor may recommend either repairing your damaged valve or replacing it with an artificial valve made of cow, pig or human heart tissue (biological tissue valve) or man-made materials (mechanical valve).
Lifestyle changes & home remedies
What are some lifestyle changes or home remedies that can help me manage endocarditis?
The following lifestyles and home remedies might help you cope with endocarditis:
- Know the signs and symptoms of endocarditis. See your doctor immediately if you develop any signs or symptoms, especially a fever that won’t go away, unexplained fatigue, any type of skin infection, or open cuts or sores that don’t heal properly.
- Pay special attention to your dental health — brush and floss your teeth and gums often, and have regular dental checkups.
- Avoid procedures that may lead to skin infections, such as body piercings or tattoos.
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Review Date: October 16, 2017 | Last Modified: December 8, 2019
Endocarditis. https://www.mayoclinic.org/diseases-conditions/endocarditis/symptoms-causes/syc-20352576. Accessed October 16, 2017.
Endocarditis. http://www.nhs.uk/Conditions/Endocarditis/Pages/Introduction.aspx. Accessed October 16, 2017.