Endocarditis

The most common type, bacterial endocarditis, occurs when germs enter your heart. These germs come through your bloodstream from another part of your body, often your mouth. Bacterial endocarditis can damage your heart valves. If untreated, it can be life-threatening. It is rare in healthy hearts.

Risk factors include having

• An abnormal or damaged heart valve
• An artificial heart valve
• Congenital heart defects

The signs and symptoms of IE can vary from person to person. They also can vary over time in the same person. Symptoms you might notice include fever, shortness of breath, fluid buildup in your arms or legs, tiny red spots on your skin, and weight loss. Your doctor will diagnose IE based on your risk factors, medical history, signs and symptoms, and lab and heart tests.

Early treatment can help you avoid complications. Treatment usually involves high-dose antibiotics. If your heart valve is damaged, you may need surgery.

If you’re at risk for IE, brush and floss your teeth regularly, and have regular dental checkups. Germs from a gum infection can enter your bloodstream. If you are at high risk, your doctor might prescribe antibiotics before dental work and certain types of surgery.

Prevention

If you’re at risk for infective endocarditis (IE), you can take steps to prevent the infection and its complications.

• Be alert to the signs and symptoms of IE. Contact your doctor right away if you have any of these signs or symptoms, especially a persistent fever or unexplained fatigue.
• Brush and floss your teeth regularly, and have regular dental checkups. Germs from a gum infection can enter your bloodstream.
• Avoid body piercing, tattoos, and other procedures that may allow germs to enter your bloodstream.

Research shows that not everyone at risk for IE needs to take antibiotics before routine dental exams and certain other dental and medical procedures.

Let your health care providers, including your dentist, know if you’re at risk for IE. They can tell you whether you need antibiotics before exams and procedures.

Risk Factors

Infective endocarditis (IE) is an uncommon condition that can affect both children and adults. It’s more common in men than women.

IE typically affects people who have abnormal hearts or other conditions that put them at risk for the infection. Sometimes IE does affect people who were healthy before the infection.

MAJOR RISK FACTORS

The germs that cause IE tend to attach and multiply on damaged, malformed, or artificial  heart valves and implanted medical devices. Certain conditions put you at higher risk for IE.

THESE INCLUDE:

• Congenital heart defects. Examples include a malformed heart or abnormal heart valves.
• Artificial heart valves, an implanted medical device in the heart (such as a pacemaker wire), or an intravenous (IV) catheter (tube) in a blood vessel for a long time.
• Heart valves damaged by rheumatic fever or calcium deposits that cause age-related valve thickening. Scars in the heart from a previous case of IE also can damage heart valves.
• IV drug use, especially if needles are shared or reused, contaminated substances are injected, or the skin isn’t properly cleaned before injection.

Causes

Infective endocarditis (IE) occurs if bacteria, fungi, or other germs invade your bloodstream and attach to abnormal areas of your heart. Certain factors increase the risk of this happening.

A common underlying factor in IE is a structural heart defect, especially faulty heart valves. Usually your immune system will kill germs in your bloodstream. However, if your heart has a rough lining or abnormal valves, the invading germs can attach and multiply in the heart.

Other factors also can play a role in causing IE. Common activities, such as brushing your teeth or having certain dental procedures, can allow bacteria to enter your bloodstream. This is even more likely to happen if your teeth and gums are in poor condition.

Having a catheter or another medical device inserted through your skin, especially for long periods, also can allow bacteria to enter your bloodstream. People who use intravenous (IV) drugs also are at risk for IE because of the germs on needles and syringes.

Bacteria also may spread to the blood and heart from infections in other parts of the body, such as the gut, skin, or genitals.

Symptoms

Infective endocarditis (IE) can cause a range of signs and symptoms that can vary from person to person. Signs and symptoms also can vary over time in the same person.

Signs and symptoms differ depending on whether you have an underlying heart problem, the type of germ causing the infection, and whether you have acute or subacute IE.

SIGNS AND SYMPTOMS OF IE MAY INCLUDE:

• Flu-like symptoms, such as fever, chills, fatigue, aching muscles and joints, night sweats, and headaches.
• Shortness of breath or a cough that won’t go away.
• A new heart murmur or a change in an existing heart murmur.
• Skin changes such as:
•  Overall paleness.
• Small, painful, red or purplish bumps under the skin on the fingers or toes.
• Small, dark, painless flat spots on the palms of the hands or the soles of the feet.
• Tiny spots under the fingernails, on the whites of the eyes, on the roof of the mouth and inside of the cheeks, or on the chest. These spots are from broken blood vessels.
• Nausea, vomiting, a decrease in appetite, a sense of fullness with discomfort on the upper left side of the abdomen, or weight loss with or without a change in appetite.
• Blood in the urine.
• Swelling in the feet, legs, or abdomen.

Diagnosis

Your doctor will diagnose infective endocarditis (IE) based on your risk factors, your medical history and signs and symptoms, and test results.

Diagnosis of IE often is based on many factors, rather than a single positive test result, sign, or symptom.

DIAGNOSTIC TESTS

Blood cultures are the most important blood tests used to diagnose IE. Blood is drawn several times over a 24-hour period. It’s put in special culture bottles that allow bacteria to grow.

Doctors then identify and test the bacteria to see which antibiotics will kill them. Sometimes the blood cultures don’t grow any bacteria, even if a person has IE. This is called culture-negative endocarditis, and it requires antibiotic treatment.

Other blood tests also are used to diagnose IE. For example, a complete blood count may be used to check the number of red and white blood cells in your blood. Blood tests also may be used to check your immune system and to check for inflammation.

Treatment

Infective endocarditis (IE) is treated with antibiotics and sometimes with heart surgery.

ANTIBIOTICS

Antibiotics usually are given for 2 to 6 weeks through an intravenous (IV) line inserted into a vein. You’re often in a hospital for at least the first week or more of treatment. This allows your doctor to make sure the medicine is helping.

If you’re allowed to go home before the treatment is done, the antibiotics are almost always continued by vein at home. You’ll need special care if you get IV antibiotic treatment at home. Before you leave the hospital, your medical team will arrange for you to receive home-based care so you can continue your treatment.

You also will need close medical follow-up, usually by a team of doctors. This team often includes a doctor who specializes in infectious diseases, a cardiologist, and a heart surgeon.

SURGERY

Sometimes surgery is needed to repair or replace a damaged heart valve or to help clear up IE. For example, IE caused by fungi often requires surgery. This is because this type of IE is harder to treat than IE caused by bacteria.