What is infective endocarditis?
Infective endocarditis is a life-threatening infection inside the lining of the heart (called the endocardium) or in the heart valves, the flaps that keep blood flowing in and out of the heart. The infection is caused by bacteria or fungus that enters the heart. It can involve one or more heart valves, the heart’s electrical system, blood vessels coming off the heart, or the heart muscle itself.
Endocarditis is uncommon, but is more likely to occur if you have certain pre-existing heart conditions. It can be treated with antibiotics, but is a medical emergency and you should go to the emergency room immediately. Depending on the type and extent of infection, heart surgery may be required to completely treat endocarditis.
Most common symptoms
I once had a patient who had infective endocarditis due to a rare, slow-growing bacteria. The endocarditis was not picked up on her initial cardiac ultrasound test. However, a more sensitive form of cardiac ultrasound called a transesophageal echocardiogram showed that she had infective endocarditis. —Dr. Sunny Varshney
Symptoms of infective endocarditis include fevers, chills, fatigue, poor appetite, night sweats, and headaches. Depending on which part of the heart is infected, some people may feel tightness or heaviness in their chest, trouble breathing or catching their breath, or feel lightheaded. The infection may also lead to joint pain, where your back, elbows, wrists, or knees feel numb or painful. Endocarditis can cause serious complications, like stroke or brain bleeds. These can cause their own set of symptoms such as blurry vision, difficulty speaking, or weakness or numbness throughout the body.
Endocarditis can develop slowly, over weeks or months, and symptoms may come and go. However, symptoms can also come on suddenly. If you suspect endocarditis, you should go to the emergency room right away.
- Fevers and chills
- Poor appetite and weight loss
- Night sweats
What causes infective endocarditis?
Endocarditis is caused by bacteria in your bloodstream infecting your heart. Bacteria can enter your bloodstream through surgery or dental procedures if there’s a breakdown in the gums. It can also enter from a cut or wound that is left untreated and gets infected. Endocarditis can also be caused by IV drug use with unsterilized needles.
Once bacteria are in your bloodstream, they will circulate inside the heart. When the bacteria latch onto heart structures, the bacteria can grow and start an infection.
What is the treatment for infective endocarditis?
There are numerous clinical trials evaluating new strategies to better manage this condition. For example, it was recently shown that some patients can be successfully treated with long-term antibiotic pills taken by mouth, rather than long-term intravenous antibiotics—which had been the standard therapy for many years. —Dr. Varshney
Once in the hospital, you will be given several types of tests to diagnose endocarditis, including blood cultures and ultrasound images of your heart. If you are diagnosed with infective endocarditis, you will be put on antibiotics through an intravenous (IV) line (directly in your vein). You’ll receive IV antibiotics for a number of days in the hospital, but may be sent home or to another care facility for long-term antibiotic therapy through an IV catheter (tube). This treatment typically lasts 6 to 8 weeks.
People who have heart failure caused by the endocarditis may be given diuretics (e.g., furosemide, torsemide). Heart failure can cause a build-up of fluid in the body. These medications help the kidneys create more urine and remove the excess fluid.
If endocarditis has damaged your heart or your heart valves, you may also need heart surgery to completely treat it. The type of surgery depends on the extent of damage and which heart structures are involved. More common procedures for endocarditis treatment include:
- Valve replacement surgery: This is an open-heart surgery that involves cutting out an infected heart valve and replacing it with a prosthetic valve.
- Pacemaker extraction: If the infection occurred because bacteria has latched onto a pacemaker device, you may need to have the pacemaker removed in order to control the source of infection.
You will be monitored with blood work and imaging tests, like an echocardiogram, throughout treatment. After treatment, you’ll likely continue to have follow-up appointments and be monitored by a cardiologist.
Who is at risk of developing endocarditis?
Ask your doctor: Are there any long-term consequences for my heart? While not usual, sometimes a heart valve replacement is needed after antibiotic treatment. It is important for you to understand if you fall into this category, so you know what to expect. —Dr. Varshney
Endocarditis can occur in anyone, but is generally rare in people without any pre-existing risk factors. Groups at higher risk include:
- People who use IV drugs.
- People with poor dental hygiene are at elevated risk because bacteria from sore gums may be introduced into the bloodstream.
- People with known abnormalities with heart valves, an artificial heart valve, or prior pacemaker or defibrillator implantation.
Some less common risk factors include having a weakened immune system, certain medical procedures like a colonoscopy or intravenous catheter insertion, and congenital heart disease.
Maintain good dental hygiene, avoid IV drugs, and make sure skin cuts or wounds are kept clean. If you have a heart condition, keep regular visits with your cardiologist. Your cardiologist may recommend preventative measures, such as taking antibiotics prior to dental procedures.