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Endocarditis

Endocarditis is an infection of the inner lining of your heart (endocardium).

Endocarditis generally occurs when bacteria or other germs from another part of your body, such as your mouth, spread through your bloodstream and attach to damaged areas in your heart. Left untreated, endocarditis can damage or destroy your heart valves and can lead to life-threatening complications. Treatments for endocarditis include antibiotics and, in certain cases, surgery.

Endocarditis is uncommon in people with healthy hearts. People at greatest risk of endocarditis have damaged heart valves, artificial heart valves or other heart defects.

Symptoms Causes Risk factors Complications Prevention

Endocarditis may develop slowly or suddenly — depending on what's causing the infection and whether you have any underlying heart problems. Endocarditis signs and symptoms vary, but may include:

  • Fever and chills
  • A new or changed heart murmur — heart sounds made by blood rushing through your heart
  • Fatigue
  • Aching joints and muscles
  • Night sweats
  • Shortness of breath
  • Paleness
  • Persistent cough
  • Swelling in your feet, legs or abdomen
  • Unexplained weight loss
  • Blood in your urine (either visible or found in a doctor's viewing of your urine under a microscope)
  • Tenderness in your spleen — an infection-fighting abdominal organ on your left side, just below your rib cage
  • Osler's nodes — red, tender spots under the skin of your fingers
  • Petechiae (puh-TEE-key-ee) — tiny purple or red spots on the skin, whites of your eyes or inside your mouth

When to see a doctor

If you develop signs or symptoms of endocarditis, see your doctor right away — especially if you have risk factors for this serious infection, such as a heart defect or a previous case of endocarditis.

Although less serious conditions can cause similar signs and symptoms, you won't know for sure until you're evaluated.

Endocarditis occurs when germs enter your bloodstream, travel to your heart, and attach to abnormal heart valves or damaged heart tissue. Bacteria cause most cases, but fungi or other microorganisms also may be responsible.

Sometimes the culprit is one of many common bacteria that live in your mouth, throat or other parts of your body. The offending organism may enter your bloodstream through:

  • Everyday oral activities. Activities such as brushing your teeth or chewing food can allow bacteria to enter your bloodstream — especially if your teeth and gums aren't healthy.
  • An infection or other medical condition. Bacteria may spread from an infected area, such as a skin sore. Gum disease, a sexually transmitted infection or an intestinal disorder — such as inflammatory bowel disease — also may give bacteria the opportunity to enter your bloodstream.
  • Catheters or needles. Bacteria can enter your body through a catheter — a thin tube that doctors sometimes use to inject or remove fluid from the body. The bacteria that can cause endocarditis can also enter your bloodstream through the needles used for tattooing or body piercing. Contaminated needles and syringes are a special concern for people who use intravenous (IV) drugs.
  • Certain dental procedures. Some dental procedures that can cut your gums may allow bacteria to enter your bloodstream.

Usually, your immune system destroys bacteria that make it into your bloodstream. Even if bacteria reach your heart, they may pass through without causing an infection.

Most people who develop endocarditis have a diseased or damaged heart valve — an ideal spot for bacteria to settle. This damaged tissue in the endocardium provides bacteria with the roughened surface they need to attach and multiply. Endocarditis does occasionally occur on previously normal heart valves.

If your heart is healthy, you're unlikely to develop endocarditis. The germs that cause infection tend to stick to and multiply in damaged or surgically implanted heart valves.

Those at highest risk of endocarditis are those who have:

  • Artificial heart valves. Germs are more likely to attach to an artificial (prosthetic) heart valve than to a normal heart valve.
  • Congenital heart defects. If you were born with certain types of heart defects, your heart may be more susceptible to infection.
  • A history of endocarditis. An episode of endocarditis damages heart tissue and valves, increasing the risk of a future heart infection.
  • Damaged heart valves. Certain medical conditions — such as rheumatic fever or infection — can damage or scar one or more of your heart valves, making them more prone to endocarditis.
  • History of intravenous (IV) illegal drug use. People who use illegal drugs by injecting them are at a greater risk of endocarditis. The needles used to inject drugs can be contaminated with the bacteria that can cause endocarditis.

If you have a known heart defect or heart valve problem, ask your doctor about your risk of developing endocarditis. Even if your heart condition has been repaired or hasn't caused symptoms, you may be at risk.

Endocarditis can cause several major complications:

  • Stroke and organ damage. In endocarditis, clumps of bacteria and cell fragments (vegetations) form in your heart at the site of the infection. These clumps can break loose and travel to your brain, lungs, abdominal organs, kidneys or extremities. This may cause various problems, including stroke or damage to other organs or tissues.
  • Infections in other parts of your body. Endocarditis can cause you to develop pockets of collected pus (abscesses) in other parts of your body, including the brain, kidneys, spleen or liver. An abscess may develop in the heart muscle itself as well, causing an abnormal heartbeat. Severe abscesses may require surgery to treat them.
  • Heart failure. Left untreated, endocarditis can damage your heart valves and permanently destroy your heart's inner lining. This can cause your heart to work harder to pump blood, eventually causing heart failure — a chronic condition in which your heart is unable to pump enough blood to meet your body's needs. If the infection progresses untreated, it's usually fatal.

To help prevent endocarditis, make sure to practice good hygiene:

  • Pay special attention to your dental health — brush and floss your teeth and gums often, and have regular dental checkups.
  • Avoid procedures that may lead to skin infections, such as body piercings or tattoos.
  • Seek prompt medical attention if you develop any type of skin infection or open cuts or sores that don't heal properly.

Preventive antibiotics

Certain dental and medical procedures may allow bacteria to enter your bloodstream. Antibiotics taken before these procedures can help destroy or control the harmful bacteria that may lead to endocarditis.

Because people with the following heart conditions are at risk of more-serious outcomes from endocarditis, they may need to take preventive antibiotics before certain medical or dental procedures to prevent endocarditis:

  • Artificial (prosthetic) heart valve
  • Previous endocarditis infection
  • Certain types of congenital heart defects
  • Heart transplant complicated by heart valve problems

Antibiotics are recommended before only the following procedures:

  • Certain dental procedures (those that cut your gum tissue or part of the teeth)
  • Procedures involving the respiratory tract, infected skin or tissue that connects muscle to bone

Antibiotics are no longer recommended before all dental procedures or for procedures of the urinary tract or gastrointestinal system.

If you've had to take preventive antibiotics in the past before your dental exams, you may be concerned about these changes. In the past, you were likely told to get antibiotics because of a concern that common dental procedures increased your risk of endocarditis. But as doctors have learned more about endocarditis prevention, they've realized that endocarditis is much more likely to occur from exposure to random germs than from a standard dental exam or surgery.

This doesn't mean it's not important to take good care of your teeth through brushing and flossing. There is some concern that infections in your mouth from poor oral hygiene might increase the risk of germs entering your bloodstream. In addition to brushing and flossing, regular dental exams are an important part of maintaining good oral health.

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