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Condition Information

INFECTIVE ENDOCARDITIS

GENERAL INFORMATION:

What is infective endocarditis? The endocardium is a thin layer of tissue that lines the inside of your heart. It covers the walls of your heart chambers (rooms), and your heart valves. Your heart valves act as one-way doors to direct the flow of blood through the heart. Infective endocarditis (en-doh-kahr-DEYE-tis) is when this lining becomes infected. The infection causes inflammation (swelling) of the endocardium. The inflammation can happen anywhere in the heart, but usually affects the heart valves.

What causes infective endocarditis?

  • Infective endocarditis is usually caused by a germ called bacteria. There are different kinds of bacteria that can cause endocarditis. Some bacteria are worse than others and may cause severe (very bad) endocarditis. Other kinds of germs, such as viruses or fungi, may also cause infective endocarditis.

  • Endocarditis is rare in people with normal hearts. Certain heart problems may allow bacteria in your blood to become stuck in your heart and cause an infection. People at risk include those with heart valve problems such as prior mitral valve prolapse or prior heart valve surgery. Other heart problems, such as an enlarged heart or being born with a heart defect, may increase your risk. Having had rheumatic fever as a child may have damaged your heart or heart valves. Other things that may cause or increase your risk of endocarditis include the following.

    • Certain health problems, such as having diabetes or being on dialysis for kidney problems. Having a long-term medical device under the skin, such as a central venous catheter, also increases your risk.

    • Certain surgeries or medical procedures. Also, having a baby at the same time you have an infection may increase your risk.

    • Having bad teeth or not keeping your teeth and gums clean. Dental procedures can also cause germs to break away from your gums and teeth. This bacteria may get into the blood and may travel to your heart.

    • Urinary procedures, such as having a catheter in your bladder.

    • Using IV (injected) street drugs.

    • Having immune system problems, such as HIV infection, certain types of cancer, or an organ transplant.

What are the signs and symptoms of infective endocarditis?

  • The symptoms you have may depend on whether your infective endocarditis is acute or subacute. The symptoms of acute endocarditis may start or worsen quickly. Also, the infection may be more likely to spread to other parts of the body with acute endocarditis. Subacute endocarditis symptoms may happen more slowly and be milder.

  • Your symptoms may depend on what germ is causing your infection, and how bad your endocarditis is. Your symptoms may also depend on the part of the heart affected, and your general health. Your symptoms may include one or more of the following:

    • Coughing and shortness of breath. You may even cough up bloody sputum (mucus) from your lungs.

    • Chest pain.

    • Fever, chills, sweating, and night sweats.

    • Loss of appetite and weight loss.

    • Headaches, back pain, abdominal (belly) pain, or muscle and joint aches. You may have swelling in your abdomen (belly) or legs.

    • Bloody urine.

    • Nausea (upset stomach) and vomiting (throwing up).

    • Blood in the whites of your eyes, or small red or purple dots on your skin. Red spots may happen on your fingers, toes, or under your fingernails. These spots may or may not be tender.

    • Irregular heartbeats. Caregivers may also hear extra heart sounds or murmurs when listening to your heart.

    • New problems with movement or feeling in your body. This may happen if your endocarditis causes problems with blood circulation in your body. You may have pale or blue skin and tenderness in your fingers or toes.

What other health problems may infective endocarditis cause? Infective endocarditis may cause problems or damage elsewhere in your body. The risk of these problems is decreased if your endocarditis is treated early. Other health problems you may have because of your endocarditis include the following.

  • Kidney problems. You may need dialysis to clean your blood if your kidneys stop working.

  • New or worsening heart problems. Examples include heart valve problems or heart failure. You may have dangerous heart rhythms.

  • The endocarditis may cause blood clots or plaque (growths) in your heart. The clots or plaque may break off and go to the brain, lungs, kidneys, or other parts of the body. This can cause problems that may be serious, even life threatening.

  • The infection of the heart lining may spread elsewhere in the body. For example, it may spread to the blood, the heart muscle itself, or other organs. This spreading infection may be dangerous or make you very sick.

How is infective endocarditis diagnosed? Your caregiver will examine you and review your medical history and symptoms. Tests may be done on your blood and urine. A chest x-ray and CT ("cat") scan may be done to check your heart and lungs. You may need an electrocardiogram, also called an EKG or ECG. An EKG is a test that senses the electrical activity of your heart muscle. You may need an ultrasound of your heart called an echocardiogram. An echocardiogram can find problems with your heart and valves that do not show up on an EKG or in an x-ray. Other tests may be done to help caregivers treat your endocarditis. You may need certain tests more than once, or new tests over time as caregivers continue to treat you.

How is infective endocarditis treated? Treatment may depend on what is causing your endocarditis, how bad it is, and your general health. You may need to stay in the hospital for tests and treatment. Antibiotics may be given in the vein to clear up the infection that is causing the endocarditis. Medicines may be given to help your heart, blood pressure, and body fluid balance. You may need aspirin or special blood thinning medicine to prevent blood clots. You may need medicine to help your breathing or ease pain. Oxygen may also help you breathe easier and help your heart. Other treatments that you may need depend on the problems your infective endocarditis has caused. For example, you may need surgery to replace a damaged heart valve.

Risks:

  • Infective endocarditis and the health problems it may cause can be serious, even life threatening. Your risks of long-term problems are decreased with early treatment. Even with treatment, your symptoms may come back.

  • Certain heart problems may increase your risk of getting endocarditis again. Having had endocarditis in the past also increases your risk of getting endocarditis again. You may need to take antibiotic medicine before dental and medical procedures to prevent this. You may even need antibiotics before getting body piercing or tattoos. Ask your caregiver if you need to take antibiotics before dental and medical procedures. Always tell caregivers about the heart problems you have had in the past.

For information and support: You may feel scared, confused, or anxious because of your heart problems. Contact the following organizations for more information.

  • American Heart Association National Center
    7272 Greenville Avenue
    Dallas, TX 75231-4596
    Phone: 1-800-242-8721
    Web Address: http://www.americanheart.org
  • American College of Cardiology
    9111 Old Georgetown Road
    Bethesda, MD 20814
    Phone: 1-301-897
    Phone: 1-800-253-4636
    Web Address: http://www.acc.org/
  • National Heart, Lung and Blood Institute
    Health Information Center
    P.O. Box 30105
    Bethesda, MD 20824-0105
    Phone: 1-301-592-8573
    Web Address: http://www.nhlbi.nih.gov/health/infoctr/index.htm

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.