Endocarditis
Infective endocarditis (IE) is a potentially fatal inflammation of your heart valves’ lining and sometimes heart chambers’ lining. This occurs when germs (usually bacteria) from elsewhere in your body enter your bloodstream and attach to and attack the lining of your heart valves and/or chambers.
Causes
Most of the time, a bacterial infection causes endocarditis. Dental procedures (particularly tooth extractions) and endoscopic examinations can cause bacteria to get into your blood.
Sometimes, bacteria from your mouth, skin, intestines, respiratory system or urinary tract may be able to get into your bloodstream when you’re:
Eating.
Brushing your teeth.
Flossing your teeth.
Pooping.
This can cause endocarditis. The bacteria rapidly form colonies, grow vegetation and produce enzymes, destroying the surrounding tissue and opening the path for invasion.
Normal heart valves are very resistant to infection. However, bacteria can attach to defects on the surface of diseased valves. Replacement heart valves are more prone to infection than normal valves.
Symptoms
Signs of an endocarditis infection include:
Fever above 100°F (38.4°C).
Sweats or chills, particularly night sweats.
Skin rash.
Pain, tenderness, redness or swelling.
Wound or cut that won’t heal.
Red, warm or draining sore.
Sore throat, scratchy throat or pain when swallowing.
Sinus drainage, nasal congestion, headaches or tenderness along your upper cheekbones.
Persistent dry or a moist cough that lasts more than two days.
White patches in your mouth or on your tongue.
Nausea, vomiting or diarrhea.
Emboli (small blood clots), hemorrhages (internal bleeding) or stroke.
Shortness of breath.
Poor appetite or weight loss.
Muscle and joint aches.
Diagnosis
Blood cultures that show bacteria or microorganisms that healthcare providers often see with endocarditis. Blood cultures — blood tests taken over time — allow a laboratory to isolate the specific bacteria that are causing your infection. To secure a diagnosis, the lab must take blood cultures before you start taking antibiotics.
Complete blood count, which can tell your provider if you have an unusually high number of white blood cells. This can mean you may have an infection.
Blood tests for substances like C-reactive protein can show you have inflammation.
Echocardiogram (ultrasound of the heart), which may show growths (vegetations on your valve), abscesses (holes), new regurgitation (leaking) or stenosis (narrowing), or an artificial heart valve that has begun to pull away from your heart tissue. Sometimes providers insert an ultrasound probe into your esophagus or “food pipe” (transesophageal echo) to get a closer, more detailed look at your heart.
Checking heart valve tissue to find out which kind of microbe you have.
Positron emission tomography (PET) or nuclear medicine scans to create images using radioactive material that can show an infection’s location.
Treatment
Endocarditis can be life-limiting. Once you get it, you’ll need quick treatment to prevent damage to your heart valves and more serious complications.
After taking your blood cultures, your healthcare provider will start you on intravenous (IV) antibiotic therapy.
They’ll use a broad-spectrum antibiotic to cover as many suspected bacterial species as possible.
As soon as they know which specific type of organism you have, they’ll adjust your antibiotics to target it.
Usually, you’ll receive IV antibiotics for as long as six weeks to cure your infection.
Your provider will monitor your symptoms throughout your therapy to see if your treatment is effective. They’ll also repeat your blood cultures.
If endocarditis damages your heart valve and any other part of your heart, you may need surgery to fix your heart valve and improve your heart function.
After you complete your treatment, your provider will determine the sources of bacteria in your blood (for example, dental infections) and treat them.
In the future, you should take prophylactic (preventive) antibiotics according to national guidelines.