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Endocarditis

When a bacterium in the bloodstream infects or inflames the inner lining of the heart’s muscle (endocardium) or the heart valves, a condition called endocarditis can develop.

Only certain forms of bacteria cause endocarditis, usually stemming from recent invasive procedures, dental surgery or intravenous drug use. People with valvular heart disease run a higher risk of developing endocarditis. In some cases, fungi or other microorganisms are the reported cause.

Immediate treatment, usually antibiotic therapy and brief hospitalization, improves the chances of full recovery. Heart valve damage, heart failure, arrhythmias or stroke can develop as a result of endocarditis, so early intervention is critical to eradicate the bacteria before it causes irreversible and life-threatening damage.

When to Call Your Doctor
Symptoms
Causes
Prevention
Diagnosis
Treatment

When to Call Your Doctor
If you’ve recently undergone any type of invasive treatment, including dental surgery, and you experience any of the symptoms described below, you should contact your doctor.

Symptoms
Depending upon the cause, the symptoms of endocarditis may develop slowly or very quickly and may include:

  • Weakness, exhaustion.
  • Fever, chills, severe night sweats, excessive sweating.
  • Shortness of breath following light activity.
  • Blood in the urine or abnormal color of urine.
  • Heart murmur.
  • Muscle or joint pain.
  • Paleness.
  • Red, painless skin spots located on the palms and soles (Janeway lesions).
  • Red, painful nodes on the pads of the fingers and toes (Osler’s nodes).
  • Weight loss or swelling of the feet, legs or stomach.

Causes
Endocarditis usually develops when bacteria flows through the bloodstream from another part of the body and lodges in the heart, causing an infection in the lining of the heart and damage to the heart valves.

Certain procedures that cause significant bleeding can carry a greater risk of endocarditis. Those procedures include:

  • Tonsillectomy or adenoidectomy.
  • Respiratory surgery.
  • Gastrointestinal or urinary tract surgery.
  • Gallbladder or prostate surgery.
  • Injection of catheters or needles (whether medical or from drug use).

Prevention
People with a high risk factor, predisposition for heart conditions or a history of endocarditis can take preventative antibiotics before a dental or medical/surgical procedure.

Following the guidelines for good oral health, such as brushing and flossing regularly, can also reduce risk.

If you have a congenital heart defect, heart murmur or other heart valve condition, you should alert your dentist or your physician before you are treated.

Diagnosis
If endocarditis is suspected based on your medical history, physical exam and symptoms, one or more of the following tests may assist your physician in confirming the diagnosis:

  • Blood tests. Red blood cells can be measured and conditions such as anemia can be identified, as well as microorganisms that may be causing the infection.
  • Echocardiogram. An “echo” uses ultrasound waves to produce a moving picture of the heart and heart valves.
  • Transesophageal echocardiogram. Infected tissue can be viewed by way of the esophagus during this test.
  • Electrocardiogram. An ECG or EKG records the electrical activity of the heart and shows abnormal rhythms (arrhythmias or dysrhythmias).
  • Chest X-ray. An X-ray will help assess lung condition.

Treatment
Treatment plans for endocarditis will vary based on the cause of the symptom and the condition of the patient, but they are likely to begin with admission to the hospital for a course of intravenous antibiotics until the type of infection or microorganism attacking the heart can be clearly identified.

Antibiotic courses, following release from hospital care, may take up to six weeks. Regular follow-up visits are advised to be sure the condition has been resolved.

If symptoms persist, surgery may be required to replace a damaged heart valve. Learn more about valve surgery.

 

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