16957 Endocarditis

Overview

Endocarditis is a rare but serious infection of the inner lining of the heart, called the endocardium. It most often affects the heart valves. The infection is usually caused by bacteria that enter the bloodstream and settle in the heart. If not treated quickly, it can damage the heart valves and become life-threatening.

No, endocarditis is rare. In the UK, it affects only about 1 to 2 people per 100,000 each year. But it is serious, so it is important to be aware of the signs.

Endocarditis can affect anyone, but it is more common in people who have artificial heart valves, have had endocarditis before, were born with certain heart problems, have heart valve disease, or use injected drugs. It also becomes more common as people get older.

Symptoms

Common symptoms

• Fever or high temperature
• Chills and night sweats
• Feeling very tired or weak
• New or changed heart murmur (a sound the heart makes, heard with a stethoscope)
• Unexplained weight loss
• Aching muscles and joints
• Small, dark red spots on the skin (called petechiae) or small tender bumps on fingers or toes

Symptoms in children

• Fever that does not go away
• Poor feeding or loss of appetite
• Irritability or excessive crying
• Rash or spots on the skin
• Breathing fast or trouble breathing
• Swollen tummy or legs

Symptoms in older adults

• Fever may be low-grade or absent
• Confusion or feeling generally unwell
• Loss of appetite and weight loss
• Fatigue that is unusual for them
• New or worsening heart failure symptoms, such as swelling of the legs or shortness of breath

Causes

Main causes

• Bacteria entering the bloodstream and attaching to damaged areas of the heart valves or lining
• Dental procedures, especially those that cause bleeding, can let bacteria into the blood
• Infections in other parts of the body, such as skin infections or gum disease
• Inserting medical devices, like catheters or pacemaker wires
• Injecting recreational drugs with unsterile needles

Risk factors

• Having an artificial (prosthetic) heart valve
• Having had endocarditis before
• Having a heart condition you were born with (congenital heart disease)
• Having a heart valve problem, such as mitral valve prolapse or valve narrowing
• Using injected drugs
• Having poor dental hygiene or untreated gum disease
• Having a long-term intravenous (IV) line for medical treatment

When to see a doctor

See a doctor urgently if:

• If you have a fever and a known heart condition, artificial valve, or a history of endocarditis, see a doctor the same day
• If you have new symptoms like sweating at night, feeling exhausted, or unexplained weight loss, make an urgent appointment
• If you have had dental work recently and develop a fever, seek medical advice promptly

Book a routine appointment if:

• If you have a heart valve condition and are due for dental work, talk to your doctor or cardiologist about whether you need antibiotics before the procedure
• If you have ongoing fatigue or a low-grade fever that continues for more than a few days, make a routine appointment

Diagnosis

To diagnose endocarditis, a doctor will ask about your symptoms, examine you, and do several tests. They will listen to your heart with a stethoscope to check for a murmur or any changes. If they suspect endocarditis, they will usually admit you to hospital for further tests.

Tests that may be done

• Blood tests, including blood cultures (taking a sample of blood and trying to grow bacteria in a lab)
• An echocardiogram – an ultrasound scan of your heart to check your valves and see if there is any infection or damage
• Sometimes a transoesophageal echocardiogram (using a small probe down your food pipe to get a closer look)
• An ECG (electrocardiogram) to check the heart's rhythm
• A chest X-ray or other scans to check for infection spreading to other organs

What to expect at your appointment

If you are being tested for endocarditis, you may need to stay in hospital for a few days while tests are done. Doctors will monitor you closely. You may need several blood tests, and you will likely see a heart specialist (cardiologist). It can be an anxious time, but the medical team will explain each step and support you.

Treatment

Endocarditis is treated in hospital. The main treatment is high-dose antibiotics given through a drip (intravenously). You will need to stay in hospital for several weeks, sometimes up to six weeks. The exact treatment depends on the type of bacteria and how severe the infection is. In some cases, surgery is needed to repair or replace a damaged heart valve.

Self-care at home

• Rest as much as possible while you are being treated and recovering
• Take all medicines exactly as prescribed and finish the full course of antibiotics
• Keep your mouth and teeth clean with a soft toothbrush, but avoid flossing unless your doctor says it is okay
• Tell your healthcare team about any new symptoms, such as new rashes or difficulty breathing

Medical treatments

Treatment usually involves a long course of intravenous antibiotics. The type and duration will be decided by your specialist team. You will have regular blood tests to check how well the treatment is working. If the infection damages a heart valve, surgery may be needed to remove infected tissue, repair the valve, or replace it with an artificial one. In severe cases, surgery might be urgent, but most people respond to antibiotics alone.

When is surgery considered?

Surgery may be needed if you develop heart failure, if the infection is caused by an especially aggressive type of bacteria, if the valve is severely damaged, or if antibiotic treatment is not working. The decision to operate is made by a team of heart doctors and surgeons, and they will explain all the options and risks to you.

Living with this condition

After you finish treatment for endocarditis, you will need regular follow-up appointments with your heart specialist. Your doctor will check how well your heart valve is working and look for any signs of the infection returning. Because endocarditis can come back, it is important to keep up with your follow-up appointments and take care of your overall health.

Lifestyle tips

• Maintain good dental hygiene – brush twice a day and see a dentist regularly
• Tell your dentist and all healthcare providers about your history of endocarditis
• If you use injected drugs, talk to a healthcare professional about support and harm-reduction services
• Stop smoking and limit alcohol to help protect your heart
• Get vaccinated against flu and other preventable infections – ask your doctor about which vaccines are right for you

Diet and exercise

Eating a balanced diet rich in fruit, vegetables, and whole grains helps keep your heart healthy. Your doctor may recommend gentle exercise, such as walking, once you feel ready. Start slowly and build up gradually. If you have heart failure, your doctor may give you specific advice on fluids and salt. Always follow the guidance of your medical team.

Mental health and emotional wellbeing

Going through a serious infection like endocarditis can be frightening and stressful. You may feel anxious about your health or about the infection coming back. These feelings are normal. Talk to your family, friends, and healthcare team about how you feel. Your doctor can also connect you with a counsellor or support group if you need more help.

Prevention

Not everyone can prevent endocarditis, but there are ways to lower your risk. Good dental hygiene is very important, because bacteria from your mouth can enter your bloodstream. Treat any infections, like skin infections or urinary infections, promptly. If you are in a high-risk group, your doctor may recommend antibiotics before certain dental procedures – always follow their advice.

Vaccines

Vaccines do not directly prevent endocarditis, but they can prevent infections that might lead to it, such as flu. Staying up to date with recommended vaccinations helps protect your overall health. Talk to your doctor about which vaccinations are appropriate for you.

Screening programmes

There is no routine screening test for endocarditis. However, if you have a heart condition that increases your risk, your doctor may recommend regular check-ups to monitor your heart valves. If you have symptoms like fever, fatigue, or new heart changes, seek medical advice early.

Complications

If left untreated

• Severe damage to heart valves, leading to heart failure
• Infection spreading to other organs, such as the lungs, brain, kidneys, or spleen
• Stroke or transient ischaemic attack (a mini-stroke) caused by pieces of infected tissue breaking off and travelling to the brain
• Pulmonary embolism (a blockage in a lung blood vessel)
• Kidney damage or kidney failure
• Life-threatening sepsis (the body's extreme response to infection)

Long-term outlook

With prompt treatment, most people recover from endocarditis. The outlook depends on how early treatment begins, the type of bacteria, and whether you have any underlying heart disease. Serious complications can occur, but modern treatments are very effective. Many people return to a normal, active life after finishing their treatment. Following your doctor's advice and keeping up with follow-up care gives you the best chance of a full recovery.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.