What is Endocarditis? Symptoms, Causes, & Treatment

Endocarditis is an infection of the inner lining of your heart chambers and valves, called the endocardium. Think of it as an unwelcome bacterial visitor that has taken up residence in one of your body's most vital organs.

This condition happens when germs, usually bacteria, enter your bloodstream and travel to your heart. While it sounds frightening, endocarditis is treatable when caught early, and understanding the signs can help you get the care you need promptly.

What are the symptoms of endocarditis?

Endocarditis symptoms can develop slowly over weeks or appear suddenly within days. The tricky part is that early signs often feel like a flu that just won't go away.

Here are the symptoms you might notice, ranging from the most common to less frequent ones:

• Fever and chills that persist for days
• Fatigue that feels more intense than usual tiredness
• Aching muscles and joints throughout your body
• Night sweats that soak your clothes or sheets
• Shortness of breath, especially during normal activities
• Chest pain that may worsen when you breathe deeply
• A new heart murmur or changes in an existing one
• Swelling in your feet, legs, or abdomen
• Small, tender red spots on your palms or soles
• Tiny red or purple spots under your nails or on your skin

Some people also experience less common symptoms like sudden weight loss, blood in their urine, or small, painless red spots in their eyes. These signs deserve immediate medical attention because they can indicate the infection is affecting other parts of your body.

What causes endocarditis?

Endocarditis develops when bacteria, fungi, or other germs enter your bloodstream and attach to damaged or abnormal heart tissue. Your heart normally has strong defenses against infection, but certain conditions can make it more vulnerable.

The most common culprits behind endocarditis include:

• Staphylococcus bacteria, which can enter through skin infections or medical procedures
• Streptococcus bacteria, often from dental infections or poor oral hygiene
• Enterococcus bacteria, sometimes linked to urinary tract or bowel infections
• HACEK group bacteria, which are less common but can cause slower-developing infections

These germs can enter your bloodstream through everyday activities like brushing your teeth, especially if you have gum disease. Medical procedures, including dental work, surgery, or even getting a tattoo, can also provide entry points.

In rare cases, fungi like Candida or Aspergillus can cause endocarditis, particularly in people with weakened immune systems or those who use intravenous drugs.

What are the risk factors for endocarditis?

Certain heart conditions and lifestyle factors can increase your chances of developing endocarditis. Understanding these risk factors helps you and your doctor take appropriate precautions.

Heart-related risk factors include:

• Previous endocarditis infection
• Artificial heart valves or other implanted heart devices
• Congenital heart defects present from birth
• Damaged heart valves from conditions like rheumatic fever
• Hypertrophic cardiomyopathy, a condition where heart muscle becomes thickened

Lifestyle and medical factors that raise your risk include:

• Intravenous drug use, which provides direct access to your bloodstream
• Poor dental hygiene or untreated dental problems
• Frequent medical procedures involving catheters or needles
• Compromised immune system from conditions like HIV or cancer treatment
• Long-term kidney dialysis

Age also plays a role, with people over 60 facing higher risk due to age-related valve changes and more frequent medical procedures.

When to see a doctor for endocarditis?

You should contact your healthcare provider immediately if you develop a persistent fever along with other concerning symptoms. Early treatment can prevent serious complications and improve your outcome significantly.

Seek emergency medical care if you experience:

• High fever with severe chills that don't improve with rest
• Sudden shortness of breath or difficulty breathing
• Chest pain that feels sharp or crushing
• Signs of stroke, such as sudden weakness, confusion, or difficulty speaking
• Severe fatigue combined with other symptoms listed above

Don't wait to see if symptoms improve on their own. Endocarditis can progress quickly, and prompt treatment is essential for the best possible outcome.

What are the possible complications of endocarditis?

Without proper treatment, endocarditis can lead to serious complications that affect your heart and other organs. Understanding these possibilities isn't meant to frighten you, but to emphasize why early treatment matters so much.

Heart-related complications can include:

• Heart valve damage that affects blood flow through your heart
• Heart failure when your heart can't pump blood effectively
• Irregular heart rhythms that may require ongoing treatment
• Abscesses or pockets of infection within heart tissue

The infection can also spread beyond your heart, causing:

• Stroke if infected material travels to your brain
• Kidney damage or kidney failure
• Lung complications, including pneumonia or lung abscesses
• Joint infections that cause persistent pain and swelling
• Enlarged spleen that may cause abdominal pain

These complications are more likely to occur in untreated cases or when treatment is delayed. With appropriate antibiotic therapy started early, most people recover well without experiencing these serious problems.

How can endocarditis be prevented?

While you can't prevent every case of endocarditis, several strategies can significantly reduce your risk. Good oral hygiene forms the foundation of prevention since your mouth is a common entry point for bacteria.

Daily prevention steps include:

• Brushing your teeth twice daily with fluoride toothpaste
• Flossing daily to remove bacteria between teeth
• Using an antibacterial mouthwash as recommended by your dentist
• Scheduling regular dental cleanings and checkups
• Treating dental problems promptly before they worsen

If you have high-risk heart conditions, your doctor may recommend antibiotic prophylaxis before certain dental or medical procedures. This involves taking antibiotics before the procedure to prevent bacteria from establishing an infection in your heart.

Additional prevention measures include avoiding intravenous drug use, keeping any cuts or wounds clean and covered, and seeking prompt treatment for any infections elsewhere in your body.

How is endocarditis diagnosed?

Diagnosing endocarditis requires a combination of clinical examination, blood tests, and imaging studies. Your doctor will start by listening to your heart and asking about your symptoms and medical history.

Blood tests play a crucial role in diagnosis:

• Blood cultures to identify the specific bacteria causing infection
• Complete blood count to check for signs of infection
• Inflammatory markers like C-reactive protein and erythrocyte sedimentation rate
• Additional tests to assess kidney and liver function

Your doctor will likely order an echocardiogram, which uses sound waves to create detailed images of your heart. This test can show infected heart valves, abscesses, or other complications. Sometimes a more detailed transesophageal echocardiogram is needed, where a probe is gently placed down your throat for clearer images.

Additional imaging studies might include CT scans or MRI to check for complications in other organs. The diagnostic process may take time, but it's essential for choosing the most effective treatment.

What is the treatment for endocarditis?

Treatment for endocarditis almost always involves intravenous antibiotics given in the hospital for several weeks. The specific antibiotics depend on which bacteria are causing your infection and how sensitive they are to different medications.

Your antibiotic treatment typically involves:

• Initial broad-spectrum antibiotics until culture results are available
• Targeted antibiotics once the specific bacteria are identified
• Four to six weeks of intravenous therapy for most cases
• Regular blood tests to monitor your response to treatment
• Adjustment of antibiotics if needed based on your progress

Some patients may qualify for outpatient antibiotic therapy after initial hospital treatment, using a PICC line or other long-term intravenous access. This allows you to receive treatment at home while maintaining your daily activities.

Surgery may be necessary in certain situations, such as when heart valves are severely damaged, when infections don't respond to antibiotics alone, or when complications like abscesses develop. Surgical options can include valve repair or replacement, depending on your specific condition.

How to manage symptoms during endocarditis treatment?

While antibiotics do the heavy lifting in treating endocarditis, you can take steps to support your recovery and manage symptoms. Rest is crucial during treatment, as your body needs energy to fight the infection.

Supportive care measures include:

• Getting plenty of sleep and avoiding strenuous activities
• Staying well-hydrated with water and other healthy fluids
• Eating nutritious foods to support your immune system
• Taking prescribed pain relievers for muscle aches and discomfort
• Monitoring your temperature and reporting persistent fever to your doctor

Pay attention to your symptoms and report any worsening to your healthcare team immediately. This includes increased shortness of breath, chest pain, severe fatigue, or new symptoms that develop during treatment.

Follow all medication instructions carefully, even if you start feeling better before finishing the full course. Stopping antibiotics early can lead to treatment failure and antibiotic resistance.

How should you prepare for your doctor appointment?

Preparing for your appointment helps ensure you get the most accurate diagnosis and appropriate treatment. Start by writing down all your symptoms, including when they started and how they've changed over time.

Information to gather before your visit:

• Complete list of current medications, including over-the-counter drugs and supplements
• Details about recent dental work, medical procedures, or hospitalizations
• History of heart problems, including any previous heart surgery
• Family history of heart conditions or endocarditis
• Recent travel history or exposure to infections

Write down questions you want to ask your doctor, such as what tests you might need, what treatment options are available, and what to expect during recovery. Having a trusted friend or family member accompany you can help you remember important information discussed during the appointment.

Bring any previous medical records related to heart conditions, recent test results, or hospital discharge summaries. This information helps your doctor understand your complete medical picture and make the best treatment decisions.

What's the key takeaway about endocarditis?

Endocarditis is a serious but treatable heart infection that requires prompt medical attention. The key to successful treatment is recognizing symptoms early and seeking immediate care, especially if you have risk factors like heart valve problems or previous endocarditis.

Most people with endocarditis recover completely when treated with appropriate antibiotics. The infection typically responds well to treatment, and complications can be prevented with early intervention. Your healthcare team will work closely with you throughout treatment to ensure the best possible outcome.

Prevention through good oral hygiene and appropriate antibiotic prophylaxis for high-risk individuals remains the best strategy. If you have concerns about your risk for endocarditis, discuss prevention strategies with your doctor during your regular checkups.