What is Endocarditis?
Endocarditis is an infection of the inner lining of your heart (endocardium).
Endocarditis typically occurs when bacteria or other germs from another part of your body, such as your mouth, spread through your bloodstream and attach to damaged areas in your heart. Left untreated, endocarditis can damage or destroy your heart valves and can lead to life-threatening complications. Treatments for endocarditis include antibiotics and, in severe cases, surgery.
Endocarditis is uncommon in people with healthy hearts. People at greatest risk of endocarditis have a damaged heart valve, an artificial heart valve or other heart defects.
What are the Symptoms?
- Abnormal urine color
- Chills (common)
- Excessive sweating (common)
- Fatigue
- Fever (common)
- 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
What are the causes?
Endocarditis occurs when germs enter your bloodstream, travel to your heart, and attach to abnormal heart valves or damaged heart tissue. Bacteria cause most cases, but fungi or other microorganisms also may be responsible.
Sometimes the culprit is one of many common bacteria that live in your mouth, throat or other parts of your body. The offending organism may enter your bloodstream through:
- Everyday oral activities. Activities such as brushing your teeth or chewing food can allow bacteria to enter your bloodstream especially if your teeth and gums are in poor condition.
- An infection or other medical condition. Bacteria may spread from an infected area, such as a skin sore. Gum disease, a sexually transmitted disease or an intestinal disorder, such as inflammatory bowel disease, also may give bacteria the opportunity to enter your bloodstream.
- Catheters or needles. Bacteria can enter your body through a catheter, a thin tube that doctors sometimes use to inject or remove fluid from the body. The bacteria that can cause endocarditis can also enter your bloodstream through the needles used for tattooing or body piercing. Contaminated needles and syringes are a concern for people who use intravenous (IV) drugs.
- Certain dental procedures. Some dental procedures that can cut your gums may allow bacteria to enter your bloodstream.
Typically, your immune system destroys bacteria that make it into your bloodstream. Even if bacteria reach your heart, they may pass through without causing an infection.
Most people who develop endocarditis have a diseased or damaged heart valve an ideal spot for bacteria to settle. This damaged tissue in the endocardium provides bacteria with the roughened surface they need to attach and multiply.
What are the risk factors?
Risk factors for developing endocarditis include:
- Injection drug use
- Permanent central venous access lines
- Prior valve surgery
- Recent dental surgery
- Weakened valves
What are the signs and tests?
Dr. Augusto Villa might suspect endocarditis in people with a history of:
- Congenital heart disease
- Intravenous drug use
- Recent dental work
- Rheumatic fever
Dr. Villa may suspect endocarditis based on your medical history and physical signs and symptoms, such as fever. Using a stethoscope to listen to your heart, Dr. Villa may hear a new heart murmur or a change in a previous heart murmur, possible signs of endocarditis.
The infection can mimic other illnesses in its early stages. Various tests may be necessary to help make the diagnosis:
- Blood tests: The most important test is a blood culture used to identify bacteria in the bloodstream. Blood tests can also help Dr. Villa identify certain conditions, including anemia, a shortage of healthy red blood cells that can be a sign of endocarditis.
- Transesophageal echocardiogram: An echocardiogram uses sound waves to produce images of your heart at work. This type of echocardiogram allows Dr. Villa to get a closer look at your heart valves. It”s often used to check for vegetations or infected tissue. During this test, an ultrasound device is passed through your mouth and into your esophagus.
- Electrocardiogram (ECG): Dr. Villa may order this noninvasive test if he or she thinks endocarditis may be causing an irregular heartbeat. During an ECG, sensors (electrodes) that can detect the electrical activity of your heart are attached to your chest and sometimes to your limbs. An ECG measures the timing and duration of each electrical phase in your heartbeat.
- Chest X-ray: X-ray images help Dr. Villa 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 infection has spread to your lungs.
- Computerized tomography (CT) scan or magnetic resonance imaging (MRI): You may need a CT or MRI scan of your brain, chest or other parts of your body if Dr. Villa thinks that infection has spread to these areas.
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 4-6 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.
Complications
- Arrhythmias such as atrial fibrillation.
- Blood clots or an infected clot that travels other organs, causing infection and severe damage.
- Brain abscess.
- Brain or nervous system changes.
- Congestive heart failure.
- Glomerulonephritis.
- Jaundice.
- Severe heart valve damage.
- Stroke.
Prevention
To help prevent endocarditis, make sure to practice good hygiene:
- 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.
- Seek prompt medical attention if you develop any type of skin infection or open cuts or sores that don”t heal properly.
Because people with the following heart conditions are at risk of more-serious outcomes from endocarditis, they may need to take preventive antibiotics before certain medical or dental procedures to prevent endocarditis:
- Artificial (prosthetic) heart valve.
- Previous endocarditis infection.
- Certain types of congenital heart defects.
- Heart transplant complicated by heart valve problems.
Preventive Antibiotics
Certain dental and medical procedures may allow bacteria to enter your bloodstream. Antibiotics taken before these procedures can help destroy or control the harmful bacteria that may lead to endocarditis.
Antibiotics are recommended only before the following procedures:
- Certain dental procedures (those that cut your gum tissue or part of the teeth).
- Procedures involving the respiratory tract, infected skin or tissue that connects muscle to bone.
Antibiotics are no longer recommended before all dental procedures or for procedures of the urinary tract or gastrointestinal system.
If you”ve had to take preventive antibiotics in the past before your dental exams, you may be concerned about these changes. In the past, you were likely told to get antibiotics because of a concern that common dental procedures increased your risk of endocarditis. But as doctors have learned more about endocarditis prevention, they”ve realized that endocarditis is much more likely to occur from exposure to random germs than from a typical dental exam or surgery.
This doesn”t mean it”s not important to take good care of your teeth through brushing and flossing. There is some concern that infections in your mouth from poor oral hygiene might increase the risk of germs entering your bloodstream. In addition to brushing and flossing, regular dental exams at least yearly are an important part of maintaining good oral health.