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Endocarditis
Valve infection; Staphylococcus aureus - endocarditis; Enterococcus - endocarditis; Streptococcus viridans - endocarditis; Candida - endocarditis
Endocarditis is inflammation of the inside lining of the heart chambers and heart valves (endocardium). It is caused by a bacterial or, rarely a fungal infection.
Causes
Endocarditis can involve the heart muscle, heart valves, or lining of the heart. Some people who develop endocarditis have a:
-
Birth defect of the heart
Birth defect of the heart
Congenital heart disease (CHD) is a problem with the heart's structure and function that is present at birth.
ImageRead Article Now Book Mark Article - Damaged or abnormal heart valve
- History of endocarditis
- New heart valve after surgery
- Parenteral (intravenous) drug addiction
Endocarditis begins when germs enter the bloodstream and then travel to the heart.
- Bacterial infection is the most common cause of endocarditis.
- Endocarditis can also be caused by fungi, such as Candida.
- In some cases, no cause can be found.
Germs are most likely to enter the bloodstream during:
- Central venous access lines
- Injection drug use, from the use of unclean (unsterile) needles
- Recent dental surgery
- Other surgeries or minor procedures to the breathing tract, urinary tract, infected skin, or bones and muscles
Symptoms
Symptoms of endocarditis may develop slowly or suddenly.
Fever, chills, and sweating are frequent symptoms. These sometimes can:
- Be present for days before any other symptoms appear
- Come and go, or be more noticeable at nighttime
You may also have fatigue, weakness, and aches and pains in the muscles or joints.
Other signs can include:
-
Small areas of bleeding under the nails (
splinter hemorrhages
)
Splinter hemorrhages
Splinter hemorrhages are small areas of bleeding (hemorrhage) under the fingernails or toenails.
Read Article Now Book Mark Article - Red, painless skin spots on the palms and soles (Janeway lesions)
- Red, painful nodes in the pads of the fingers and toes (Osler nodes)
-
Shortness of breath
with activity
Shortness of breath
Breathing difficulty may involve:Difficult breathingUncomfortable breathingFeeling like you are not getting enough air
ImageRead Article Now Book Mark Article - Swelling of feet, legs, abdomen
Exams and Tests
The health care provider may detect a new heart murmur , or a change in a past heart murmur.
Heart murmur
A heart murmur is a blowing, whooshing, or rasping sound heard during a heartbeat. The sound is caused by turbulent (rough) blood flow through the h...
An eye exam may show bleeding in the retina and a central area of clearing. This finding is known as Roth spots. There may be small, pinpoint areas of bleeding on the surface of the eye or the eyelids.
Tests that may be done include:
-
Blood culture
to help identify the bacteria or fungus that is causing the infection
Blood culture
A blood culture is a laboratory test to check for bacteria or other germs in a blood sample.
Read Article Now Book Mark Article -
Complete blood count
(CBC), C-reactive protein (CRP), or
erythrocyte sedimentation rate
(ESR)
Complete blood count
A complete blood count (CBC) test measures the following:The number of red blood cells (RBC count)The number of white blood cells (WBC count)The tota...
ImageRead Article Now Book Mark ArticleErythrocyte sedimentation rate
ESR stands for erythrocyte sedimentation rate. It is commonly called a "sed rate. "It is a test that indirectly measures how much inflammation is in...
Read Article Now Book Mark Article -
An
echocardiogram
to look at the heart valves
Echocardiogram
An echocardiogram is a test that uses sound waves to create pictures of the heart. The picture and information it produces is more detailed than a s...
ImageRead Article Now Book Mark Article
Treatment
You may need to be in hospital to get antibiotics through a vein (IV or intravenously). Blood cultures and tests will help your provider choose the best antibiotic.
You will then need long-term antibiotic therapy.
- People most often need therapy for 4 to 6 weeks to fully kill all the bacteria from the heart chambers and valves.
- Antibiotic treatments that are started in the hospital will need to be continued at home.
Surgery to replace the heart valve is often needed when:
- The infection is breaking off in little pieces, resulting in strokes.
- The person develops heart failure as a result of damaged heart valves.
- There is evidence of more severe organ damage.
Outlook (Prognosis)
Getting treatment for endocarditis right away improves the chances of a good outcome.
More serious problems that may develop include:
-
Brain abscess
Brain abscess
A brain abscess is a collection of pus, immune cells, and other material in the brain, usually from a bacterial or fungal infection.
ImageRead Article Now Book Mark Article - Further damage to the heart valves, causing heart failure
- Spread of the infection to other parts of the body
- Stroke, caused by small clots or pieces of the infection breaking off and traveling to the brain
When to Contact a Medical Professional
Call your provider if you notice the following symptoms during or after treatment:
- Blood in urine
- Chest pain
- Fatigue
- Fever that doesn't go away in two or three days
- Fever
- Numbness
- Weakness
- Weight loss without change in diet
Prevention
The American Heart Association recommends preventive antibiotics for people at risk for infectious endocarditis, such as those with:
- Certain birth defects of the heart
- Heart transplant and valve problems
- Man-made (prosthetic) heart valves
- Past history of endocarditis
These people should receive antibiotics when they have:
- Dental procedures that are likely to cause bleeding
- Procedures involving the breathing tract
- Procedures involving the urinary tract system
- Procedures involving the digestive tract
- Procedures on skin infections and soft tissue infections
References
Baddour LM, Freeman WK, Suri RM, Wilson WR. Cardiovascular infections. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine . 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 64.
Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation . 2015;132(15):1435-1486. PMID: 26373316 www.ncbi.nlm.nih.gov/pubmed/26373316 .
Fowler VG Jr, Scheld WM, Bayer AS. Endocarditis and intravascular infections. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases . 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 82.
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Heart, section through the middle - illustration
The interior of the heart is composed of valves, chambers, and associated vessels.
Heart, section through the middle
illustration
-
Heart, front view - illustration
The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.
Heart, front view
illustration
-
Janeway lesion - close-up - illustration
Janeway lesions are seen in people with acute bacterial endocarditis. They appear as flat, painless, red to bluish-red spots on the palms and soles.
Janeway lesion - close-up
illustration
-
Janeway lesion on the finger - illustration
Janeway lesions appear as flat, painless, red or reddish-blue patches on the hands and soles of people with acute bacterial endocarditis.
Janeway lesion on the finger
illustration
-
Heart valves - illustration
The valves of the heart open and close to control the flow of blood entering or leaving the heart.
Heart valves
illustration
-
Heart, section through the middle - illustration
The interior of the heart is composed of valves, chambers, and associated vessels.
Heart, section through the middle
illustration
-
Heart, front view - illustration
The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.
Heart, front view
illustration
-
Janeway lesion - close-up - illustration
Janeway lesions are seen in people with acute bacterial endocarditis. They appear as flat, painless, red to bluish-red spots on the palms and soles.
Janeway lesion - close-up
illustration
-
Janeway lesion on the finger - illustration
Janeway lesions appear as flat, painless, red or reddish-blue patches on the hands and soles of people with acute bacterial endocarditis.
Janeway lesion on the finger
illustration
-
Heart valves - illustration
The valves of the heart open and close to control the flow of blood entering or leaving the heart.
Heart valves
illustration
Review Date: 11/27/2016
Reviewed By: Arnold Lentnek, MD, Infectious Diseases Medical Practice of NY and Clinical Research Centers of CT. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
