Overview Of Endocarditis
Endocarditis is inflammation of the inside lining of the heart chambers and heart valves (endocardium). It is caused by a bacterial or, rarely a fungal infection.
Commonly Associated With
Valve infection; Staphylococcus aureus – endocarditis; Enterococcus – endocarditis; Streptococcus viridans – endocarditis; Candida – endocarditis
Causes Of Endocarditis
Endocarditis can involve the heart muscle, heart valves, or lining of the heart.
Some people who develop endocarditis have a:
- Birth defect of the heart
- Damaged or abnormal heart valve
- History of endocarditis
- New heart valve after surgery
- Parenteral (intravenous) drug addiction
- Endocarditis begins when germs enter the bloodstream and then travel to the heart.
Bacterial infection is the most common cause of endocarditis.
Endocarditis can also be caused by fungi, such as Candida.
In some cases, no cause can be found.
Germs are most likely to enter the bloodstream during:
- Central venous access lines
- Injection drug use, from the use of unclean (unsterile) needles
- Recent dental surgery
- Other surgeries or minor procedures to the breathing tract, urinary tract, infected skin, or bones and muscles
Symptoms Of Endocarditis
Symptoms of endocarditis may develop slowly or suddenly.
Fever, chills, and sweating are frequent symptoms. These sometimes can:
- Be present for days before any other symptoms appear
- Come and go, or be more noticeable at nighttime
- You may also have fatigue, weakness, and aches and pains in the muscles or joints.
Other signs can include:
- Small areas of bleeding under the nails (splinter hemorrhages)
- Red, painless skin spots on the palms and soles (Janeway lesions)
- Red, painful nodes in the pads of the fingers and toes (Osler nodes)
- Shortness of breath with activity
- Swelling of feet, legs, abdomen
Exams & Tests
The health care provider may detect a new heart murmur or a change in a past heart murmur.
An eye exam may show bleeding in the retina and a central area of clearing. This finding is known as Roth spots. There may be small, pinpoint areas of bleeding on the surface of the eye or the eyelids.
Tests that may be done include:
- Blood culture to help identify the bacteria or fungus that is causing the infection
- Complete blood count (CBC), C-reactive protein (CRP), or erythrocyte sedimentation rate (ESR)
- An echocardiogram to look at the heart valves
Treatment Of Endocarditis
You may need to be in hospital to get antibiotics through a vein (IV or intravenously). Blood cultures and tests will help your provider choose the best antibiotic.
You will then need long-term antibiotic therapy.
People most often need therapy for 4 to 6 weeks to kill all the bacteria from the heart chambers and valves.
Antibiotic treatments that are started in the hospital will need to be continued at home.
Surgery to replace the heart valve is often needed when:
- The infection is breaking off in little pieces, resulting in strokes.
- The person develops heart failure as a result of damaged heart valves.
- There is evidence of more severe organ damage.