Endocarditis

Endocarditis is a rare and potentially life-threatening infection of the heart's valves or inner lining. Certain risk factors like having an underlying heart valve problem, using intravenous drugs, or living with an implanted pacemaker can increase your risk of experiencing endocarditis. Endocarditis cases have been rising in recent decades—and researchers believe that the increase in the number of people who have pacemakers may be the reason.

Bacterial infections are responsible for most cases of endocarditis, but the condition can also occur due to a fungal infection. If you develop endocarditis, you may experience symptoms like fever, chills, fatigue, and shortness of breath. See your healthcare provider if you have these symptoms or may be at risk of a heart infection. Doing so can help you get the treatment you need and prevent serious complications from occurring.

Endocarditis Symptoms

Endocarditis can be difficult to recognize since many of the symptoms can mimic the signs of other health conditions. However, if you notice the following signs of the infection, it's important to see your healthcare provider sooner rather than later:

• Fever
• Chills
• Sweating
• Fatigue
• Malaise
  
• Difficulty breathing
• Chest pain that worsens when you breathe
• Cough
• Swelling in the legs or feet
• Increased heart rate
• Joint or muscle pain
  
• Heart murmur
• Blood in the urine
• Loss of appetite
• Unintentional weight loss

Less commonly, endocarditis can cause changes in your skin and nails. These include painful red or purple bumps on the fingertips, painless spots on the soles of the feet, and small red or brown streaks under the fingernails.

Causes

Endocarditis occurs when microorganisms enter the bloodstream and settle on the heart valves or inner lining of your heart. This can happen when there is an infection elsewhere in your body (such as on your skin or in your mouth) that allows germs to enter the bloodstream.

Bacterial infections like strep throat and staph infections are common ways these germs can enter your blood. However, some fungal infections (like candida) may also increase your risk of developing endocarditis.

Risk Factors

Your body relies on your immune system to effectively fight off infections. When your immune system isn't functioning properly, infections like endocarditis are more likely to occur. The following factors can disrupt your immune health and raise your risk of developing endocarditis:

• Having a pacemaker, defibrillator, or artificial heart valve
• Using intravenous drugs
• Experiencing underlying heart valve problems, such as valve stenosis or regurgitation
• Living with autoimmune disorders like HIV, lupus, or multiple sclerosis
• Taking immunosuppressant medications
  

Diagnosis

If you're experiencing symptoms of endocarditis, it's important to see your healthcare provider as soon as you can to avoid complications from occurring and get the medical treatment you need. During your appointment, you can expect your provider to ask about your medical history, lifestyle habits, and symptoms. They will also perform a physical exam and use a stethoscope to check for a heart murmur.

Your provider may also order additional tests to confirm a diagnosis and identify what's causing your symptoms. These exams may include:

• Blood cultures: Check for the presence of bacteria in your blood
• Blood tests: Measures blood counts and liver or kidney function to look for complications
• Electrocardiogram (EKG): Assess the heart's rhythm
• Chest X-ray: Creates images to check for fluid in the lungs and measure the size of the heart
• Transthoracic echocardiogram (TTE): Uses soundwaves to assess heart function
• Transesophageal echocardiogram (TEE): Helps your healthcare provider properly visualize the heart
  

F-fluorodeoxyglucose with low-dose or contrast-enhanced computed tomography (FDG-PET/CT) is becoming more common—for example, if there's an implanted device and/or lesions in the heart. FDG-PET/CT is a computed tomography (CT) scan—an imaging test that uses X-rays that generate images—with an F-fluorodeoxyglucose (FDG) tracer, or contrast material. The FDG identifies abnormal tissue.

Endocarditis Treatments

Should you receive a diagnosis for this heart infection, your healthcare team will recommend a proper treatment plan to help reduce your symptoms. Most endocarditis treatments include antibiotics or antifungal medication to target and rid your body of the germ that's causing your infection. These medications are usually administered through an intravenous (IV) line directly into your blood, where they can kill and prevent the growth of the infection.

However, sometimes surgery is necessary to remove the infection and repair any affected valves. The following situations may require surgery:

• Severe problems with the heart valves, such as regurgitation (blood leaking backward in the heart)
• Heart failure, which occurs when your heart cannot provide adequate blood flow to the rest of your organs
• Blood clots that travel to the heart
• Endocarditis symptoms that continue despite treatment with medications

How To Prevent Endocarditis

While endocarditis is not always preventable, there are some ways to lower the risk of developing endocarditis. Some people with underlying heart problems can prevent endocarditis by taking antibiotics before certain medical procedures or dental work. However, everyone can practice the following strategies to lower the risk of a heart infection:

• Practice good dental hygiene, including tooth brushing, flossing, and regular appointments with a dentist
• Treat any infections, such as gum disease or bacterial skin infections, to prevent bacteria from spreading to your bloodstream
• Avoid intravenous (IV) drug use

Complications

Unfortunately, endocarditis is a serious condition. Without prompt treatment, you may be at a higher risk of severe complications. These include:

• Heart failure
• Damage to the heart valves
• Abnormal heart rhythms such as bradycardia (slow heart rate)
• Stroke
• Blood clots
• Rupture of the heart walls

That said, if you're experiencing symptoms, seeing a healthcare provider for treatment immediately can help lower the risk of these complications and improve the overall outlook of this condition.

A Quick Review

Endocarditis is an infection of the heart valves or inner lining of the heart. Bacterial and fungal infections that spread to the bloodstream are common culprits of this condition. Unfortunately, this infection is very serious and without treatment, you may experience life-threatening complications like heart failure or stroke.

If you do develop signs of the infection (such as fever, fatigue, or swelling), it's important to get treatment right away to improve your quality of life and reduce symptoms.