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Endocarditis
Introduction
Endocarditis is an inflammation of the heart’s inner
lining. This lining is called the endocardium. The
condition is also called infective endocarditis, or IE.
The term “endocarditis” is also used to describe an
inflammation of the endocardium due to other
conditions. This program focuses on endocarditis
related to infection.
Endocardium
Endocarditis can damage the valves in the heart. If
left untreated, it can be life threatening.
Endocarditis is rare in healthy hearts.
Heart
This reference summary explains endocarditis. It covers symptoms, causes, diagnosis,
and treatment.
The Endocardium
The endocardium is the inner lining of the heart. The heart pumps blood to the lungs
and to the rest of the body. The endocardium includes fibers that are important to
synchronize the beating of the heart.
The cells and tissues of the endocardium
cover heart valves. The endocardium is
of the same type of tissue that
continuously grows to make the inner
lining of blood vessels. That is why an
infection of the endocardium can result in
damage to the heart valves.
The heart has 4 chambers: the right
atrium, right ventricle, left atrium, and left
ventricle.
Left Atrium
Left Ventricle
Right Atrium
Right Ventricle
This document is for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a
recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the
advice of a doctor or a healthcare professional for your specific condition.
©1995-2016, The Patient Education Institute, Inc. www.X-Plain.com
Last reviewed: 04/19/2016
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The heart valves separate each atrium from the ventricles and the ventricles from the
pulmonary artery and aorta. These valves allow the blood to only go in one direction.
Causes
Endocarditis is inflammation of the endocardium, the inner lining of the heart. It is
caused by bacteria, fungi, or other germs. If these germs invade the bloodstream, they
can attach to abnormal areas of the heart.
Usually the immune system will kill germs in the bloodstream. However, if a person’s
heart has a rough lining or abnormal valves, the germs can attach and multiply in the
heart.
Because germs attach to abnormal areas,
people with certain heart problems are at a
higher risk of getting endocarditis. Examples
of these heart problems include:
• An abnormal or damaged heart valve
• An artificial heart valve
• A severe case of mitral valve prolapse
Mitral Valve Prolapse
Mitral valve prolapse is a condition in which the heart’s mitral valve doesn’t work well.
The flaps of the valve are “floppy” and don’t close tightly. These flaps normally help
seal or open the valve.
Other factors can also play a role in causing endocarditis. Common activities, such as
brushing your teeth or having certain dental procedures, can allow bacteria to enter
your bloodstream. This is even more likely to happen if your teeth and gums are in
poor condition.
Bacteria can enter the bloodstream through a catheter or other medical device inserted
through the skin, especially if these are kept in place for a long time. People who use
IV drugs are also at risk of endocarditis because of germs on needles and syringes.
Other infections in the body may sometimes spread to the bloodstream and cause
endocarditis.
This document is for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a
recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the
advice of a doctor or a healthcare professional for your specific condition.
©1995-2016, The Patient Education Institute, Inc. www.X-Plain.com
Last reviewed: 04/19/2016
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Symptoms
Endocarditis can cause a range of signs and symptoms. These signs and symptoms
can vary greatly from person to person. They can also vary over time in the same
person.
Signs and symptoms of endocarditis differ depending on:
• The type of germ causing the infection
• Whether the infection develops quickly or slowly
• Whether the person has an underlying heart problem
Endocarditis commonly causes flu-like symptoms, including:
• Aching muscles and joints
• Chills
• Fever
• Headaches
• Night sweats
• Tiredness
The skin can also be affected by endocarditis. Common skin symptoms are:
• Paleness
• Small, painful, red or purplish bumps under the skin on the fingers or toes
• Small, dark, painless flat spots on the palms of the hands or soles of the feet
Endocarditis can also cause tiny spots on the skin from
broken blood vessels. These spots may appear:
• Inside the cheeks
• On the chest
• On the roof of the mouth
• On the whites of the eyes
• Under the fingernails
This document is for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a
recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the
advice of a doctor or a healthcare professional for your specific condition.
©1995-2016, The Patient Education Institute, Inc. www.X-Plain.com
Last reviewed: 04/19/2016
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Other common symptoms of endocarditis include:
• A new heart murmur or a change in an existing heart murmur
• Blood in the urine
• Change in appetite
• Nausea or vomiting
• Shortness of breath or cough that won’t go away
• Swelling in the feet, legs, or abdomen
• Weight loss
A heart murmur is an extra or unusual sound heard during a heartbeat.
The symptoms of endocarditis may be caused by diseases other than endocarditis. If
you have these symptoms, make sure to see a healthcare provider to find out what is
causing your symptoms.
Complications
As the germs that cause endocarditis multiply in the heart, they form clumps with other
cells and matter found in the blood. These clumps are called vegetations.
As endocarditis worsens, pieces of vegetations can break off and travel to other parts
of the body. There, the pieces can block blood flow or cause a new infection. As a
result, endocarditis can cause a range of complications.
Heart problems are the most common complication of
endocarditis. These problems may include:
• Heart failure
• Heart murmur
• Heart valve damage
• Problems with the heart’s electrical system
Rarely, endocarditis can also lead to a heart attack.
The central nervous system can also be affected by
endocarditis. The most common complication is when bits of the
vegetation, called emboli, break away and lodge in the brain.
The emboli can cause infections in the brain, strokes, or
seizures.
This document is for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a
recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the
advice of a doctor or a healthcare professional for your specific condition.
©1995-2016, The Patient Education Institute, Inc. www.X-Plain.com
Last reviewed: 04/19/2016
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Endocarditis can also affect other organs in the body, such as the lungs, kidneys, and
spleen. A vegetation or blood clot going to the lungs can cause a pulmonary embolism
and lung damage. Other lung complications include pneumonia and a buildup of fluid
or pus around the lungs.
A pulmonary embolism is a sudden blockage in a lung artery. This blockage can
damage the lung by limiting blood flow. Pneumonia is an infection in one or both lungs.
Kidney infections and kidney damage can also be caused by endocarditis. In some
cases, endocarditis can cause kidney failure.
In some people who have endocarditis, the spleen enlarges and can become
damaged. The spleen is an organ located on the left side of the abdomen near the
stomach. It filters the blood, stores blood cells, and destroys old blood cells.
Diagnosis
Your healthcare provider will make a diagnosis based
on your medical history, symptoms, and test results.
There is no single test that can diagnose
endocarditis.
Your healthcare provider will first ask you about your
medical history and symptoms. He or she will also
perform a physical exam and run blood tests.
Blood cultures are the most important blood test used
to diagnose endocarditis. For this test, blood is drawn
several times over a 24-hour period. The blood is put
into special culture bottles that allow bacteria to grow.
Doctors then identify the bacteria and see which
antibiotics will kill them.
Echocardiography, or echo, is a painless test that uses sound waves to create pictures
of the heart. It can help doctors diagnose endocarditis.
An EKG is a test that detects and records the heart’s electrical activity. It may be used
to see if endocarditis is affecting the heart’s rhythm.
This document is for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a
recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the
advice of a doctor or a healthcare professional for your specific condition.
©1995-2016, The Patient Education Institute, Inc. www.X-Plain.com
Last reviewed: 04/19/2016
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Treatment
Endocarditis is treated with antibiotics. In some cases, surgery may also be needed.
Antibiotics are usually given for 2 to 6 weeks
through an intravenous, or IV, line inserted into
a vein. The first week of treatment is often done
in the hospital. If you are allowed to go home
before treatment is done, the antibiotics may be
continued at home. You will need special care
for the IV treatment. Otherwise, antibiotics can
be given during visits to your doctor’s office.
Your doctor will monitor your condition carefully
to prevent complications. Sometimes your
doctor will refer you to a specialist in infectious
diseases or a heart specialist for treatment.
In some cases, surgery is needed to repair or replace a damaged heart valve or to help
clear up the infection. Endocarditis caused by a fungal infection often requires surgery.
Summary
Endocarditis is an inflammation of the endocardium, or the heart’s inner lining. It can
damage the valves in the heart and lead to other complications. If left untreated, it can
be life threatening.
Endocarditis is caused by bacteria, fungi, or other
germs. If these germs invade the bloodstream, they
can attach to abnormal areas of the heart.
Endocarditis is rare in healthy hearts. Endocarditis is
treated with antibiotics given through an IV. In some
cases, surgery may also be needed.
Let your healthcare providers know if you have heart
abnormalities that put you at risk for endocarditis. This
includes your dentist. They can tell you whether you
need antibiotics before exams and procedures to
prevent endocarditis.
This document is for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a
recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the
advice of a doctor or a healthcare professional for your specific condition.
©1995-2016, The Patient Education Institute, Inc. www.X-Plain.com
Last reviewed: 04/19/2016
ctf60101
6