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Endocarditis
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Overview
Endocarditis is a life-threatening
inflammation of the inner lining of
your heart's chambers and valves
(endocardium).

Endocarditis is usually caused by

an infection. Bacteria, fungi or
other germs from another part of
your body, such as your mouth, Endocarditis
spread through your bloodstream
and attach to damaged areas in
your heart. If it's not treated
quickly, endocarditis can damage or destroy your heart
valves. Treatments for endocarditis include
medications and, sometimes, surgery.

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People at greatest risk of endocarditis usually have

damaged heart valves, artificial heart valves or other
heart defects.

Symptoms
Endocarditis may develop slowly or suddenly,
depending on what germs are causing the infection
and whether you have any underlying heart problems.
Signs and symptoms of endocarditis can vary from
person to person.

Common signs and symptoms of endocarditis include:

Aching joints and muscles

Chest pain when you breathe

Fatigue

Flu-like symptoms, such as fever and chills

Night sweats

Shortness of breath

Swelling in your feet, legs or abdomen

A new or changed heart murmur, which is the

heart sound made by blood rushing through your
heart

Less common signs and symptoms of endocarditis can

include:

Unexplained weight loss

Blood in your urine, which you might be able to

see or that your doctor might see when he or she
views your urine under a microscope

Tenderness in your spleen, which is an infection-

fighting organ located just below your left rib cage

Red spots on the soles of your feet or the palms

of your hands (Janeway lesions)

Red, tender spots under the skin of your fingers

or toes (Osler's nodes)

Tiny purple or red spots, called petechiae (puh-

TEE-kee-ee), on the skin, in the whites of your
eyes or inside your mouth

When to see a doctor

If you have signs or symptoms of endocarditis, see
your doctor as soon as possible — especially if you
have risk factors for this serious infection, such as a
heart defect or history of endocarditis. Although less
serious conditions can cause similar signs and
symptoms, you won't know for sure until you're
evaluated by your doctor.

If you've been diagnosed with endocarditis, tell your

doctor about any signs or symptoms that may mean
your infection is getting worse, such as:

Chills

Fever

Headaches

Joint pain

Shortness of breath

If you're being treated with antibiotics for endocarditis,

tell your doctor if you develop diarrhea, a rash, itching
or joint pain. These signs and symptoms may mean
you're having a reaction to your prescribed antibiotic.

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Causes
Endocarditis occurs when germs, usually bacteria,
enter your bloodstream, travel to your heart, and
attach to abnormal heart valves or damaged heart
tissue. Fungi or other germs also may cause
endocarditis.

Usually, your immune system destroys any harmful

bacteria that enter your bloodstream. However,
bacteria that live in your mouth, throat or other parts of
your body, such as your skin or your gut, can
sometimes cause endocarditis under the right
circumstances.

Bacteria, fungi and other germs that cause

endocarditis might enter your bloodstream through:

Improper dental care. Proper toothbrushing and

flossing helps prevent gum disease. If you don't
take good care of your teeth and gums, brushing
could cause unhealthy gums to bleed, giving
bacteria a chance to enter your bloodstream.
Some dental procedures that can cut your gums
also may allow bacteria to enter your
bloodstream.

Catheters. Bacteria can enter your body through

a thin tube that doctors sometimes use to inject or
remove fluid from the body (catheter). This is
more likely to occur if the catheter is in place for a
long period of time. For example, you may have a
catheter if you need long-term dialysis.

Illegal IV drug use. Contaminated needles and

syringes are a special concern for people who
use illegal IV drugs, such as heroin or cocaine.
Often, individuals who use these types of drugs
don't have access to clean, unused needles or
syringes.

Risk factors
You're more likely to develop
endocarditis if you have faulty,
diseased or damaged heart
valves. However, endocarditis
does occasionally occur in
previously healthy people.

You have an increased risk of

endocarditis if you have:
Chambers and
Older age. Endocarditis valves of the
occurs most often in older heart
adults over age 60.

Artificial heart valves. Germs are more likely to

attach to an artificial (prosthetic) heart valve than
to a normal heart valve.

Damaged heart valves. Certain medical

conditions, such as rheumatic fever or infection,
can damage or scar one or more of your heart
valves, increasing the risk of infection.

Congenital heart defects. If you were born with

certain types of heart defects, such as an
irregular heart or abnormal heart valves, your
heart may be more susceptible to infection.

Implanted heart device. Bacteria can attach to

an implanted device, such as a pacemaker,
causing an infection of the heart's lining.

A history of endocarditis. Endocarditis can

damage heart tissue and valves, increasing the
risk of a future heart infection.

A history of illegal IV 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.

Poor dental health. A healthy mouth and healthy

gums are essential for good health. If you don't
brush and floss regularly, bacteria can grow
inside your mouth and may enter your
bloodstream through a cut on your gums.

Long-term catheter use. Having a catheter in

place for a long period of time (indwelling
catheter) increases your risk of endocarditis.

If you're at risk of endocarditis, let all of your doctors

know. You may want to request an endocarditis wallet
card from the American Heart Association. Check with
your local chapter or print the card from the
association's website.

Complications
In endocarditis, clumps made of germs and cell pieces
form an abnormal mass in your heart. These clumps,
called vegetations, can break loose and travel to your
brain, lungs, abdominal organs, kidneys, or arms and
legs.

As a result, endocarditis can cause several

complications, including:

Heart problems, such as heart murmur, heart

valve damage and heart failure

Stroke

Pockets of collected pus (abscesses) that

develop in the heart, brain, lungs and other
organs

Blood clot in a lung artery (pulmonary embolism)

Kidney damage

Enlarged spleen

Prevention
You can take the following steps to help prevent
endocarditis:

Know the signs and symptoms of

endocarditis. See your doctor immediately if you
develop any signs or symptoms, especially a
fever that won't go away, unexplained fatigue, any
type of skin infection, or open cuts or sores that
don't heal properly.

Take care of your teeth and gums. Brush and

floss your teeth and gums often, and have regular
dental checkups. Good dental hygiene is an
important part of maintaining your overall health.

Don't use illegal IV drugs. Dirty needles can

send bacteria into your bloodstream, increasing
your risk of endocarditis.

Preventive antibiotics
Certain dental and medical procedures may allow
bacteria to enter your bloodstream.

If you're at high risk of endocarditis, the American

Heart Association recommends taking antibiotics an
hour before having any dental work done.

You're at high risk of endocarditis and need antibiotics

before dental work if you have:

A history of endocarditis

A man-made (prosthetic mechanical) heart valve

A heart transplant, in some cases

Certain types of congenital heart disease

Congenital heart disease surgery in the last six

months

If you have endocarditis or any type of congenital heart

disease, talk to your doctor and dentist about your
risks and whether you need preventive antibiotics.
By Mayo Clinic Staff

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Diagnosis & treatment

Nov. 14, 2020

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