Endocarditis

Overview

Endocarditis (say: en-doh-kar-DYE-tis) is an infection of the inner lining of the heart and the heart valves. The valves are the flaps that keep blood flowing in the right direction. Germs, usually bacteria, get into the bloodstream and stick to the valve or lining. This can damage the valves and cause serious health problems. It is not the same as a common cold or flu. It needs medical care.

Endocarditis is uncommon in the general population. But it is a serious condition that needs prompt medical attention.

It can affect anyone, but it is more likely in people with an artificial heart valve, previous endocarditis, certain heart defects, long-term tubes into the bloodstream, weakened immune systems, or injection drug use. Older adults and people with poor dental health may also be at higher risk.

Symptoms

Common symptoms

• Fever, often with chills or sweating
• Feeling very tired or weak
• Shortness of breath or a new cough
• Night sweats
• Weight loss you cannot explain
• Muscle or joint aches
• Small red or purple spots on the skin, inside the mouth, or under the nails (less common)
• A new heart murmur — an extra or changed sound your doctor hears through a stethoscope

Symptoms in children

• Fever that does not clearly go away
• Poor feeding, tiredness, or irritability in babies
• Unusual sleepiness or low energy in older children
• Breathing problems or a new heart sound found by a doctor
• Symptoms can be vague, so tell the doctor about any heart condition or long-term line

Symptoms in older adults

• Fever may be low or missing
• Confusion, new forgetfulness, or unusual sleepiness
• Tiredness, weakness, or falls
• Shortness of breath or worsening heart failure symptoms
• Loss of appetite or weight loss

Causes

Main causes

• Germs, most often bacteria, enter the bloodstream and settle on the heart lining or a valve.
• Common entry points include the mouth, skin, gut, urinary tract, or an infected wound.
• In healthcare settings, long-term tubes or lines into the blood can be a way for germs to get in.
• Fungi and other germs can cause it, but this is less common.

Risk factors

• An artificial (prosthetic) heart valve
• Previous endocarditis
• Certain congenital heart defects — heart problems present from birth
• A long-term central line or device in the bloodstream
• Injection drug use
• Poor dental health or gum disease
• A weakened immune system from illness or treatment
• Recent medical or dental procedure in someone already at high risk

When to see a doctor

See a doctor urgently if:

• You have a fever and you have a heart valve problem, an artificial valve, or past endocarditis.
• You have a fever that will not go away and you feel increasingly unwell.
• You notice a new heart murmur or your doctor hears one.
• You have unexplained weight loss, night sweats, or weeks of tiredness.

Book a routine appointment if:

• You have a heart condition and are planning dental work or a procedure — ask your care team whether you need any extra steps.
• You have ongoing tiredness, low-grade fever, or aches that do not settle.
• You want to check your heart health or discuss your risk.

Diagnosis

A doctor will ask about your symptoms, past health, medicines, dental health, and any heart conditions. They will examine you, including listening to your heart. If endocarditis is possible, they will arrange tests, often in hospital.

Tests that may be done

• Blood tests to check for infection and inflammation
• Blood cultures — blood samples taken to look for germs and help choose the right treatment
• Echocardiogram — an ultrasound scan of the heart that shows the valves and lining
• Electrocardiogram (ECG) — a painless test of the heart's electrical rhythm
• Chest X-ray or other imaging if needed
• Urine tests to check for kidney problems or blood

What to expect at your appointment

You may need to stay in hospital while tests are done. Blood cultures often need more than one sample. An echocardiogram is painless and usually takes about 30 to 60 minutes. Results help the care team confirm whether there is an infection and whether the heart valves are damaged.

Treatment

Endocarditis is treated with germ-fighting medicine, usually in hospital at first. The medicine is often given through a vein for several weeks. Some people need surgery to repair or replace a damaged valve or to clear an infection that will not settle.

Self-care at home

• Get plenty of rest while you recover and build activity back slowly.
• Take all medicines exactly as your care team tells you, even if you feel better.
• Keep all follow-up appointments and blood tests.
• Tell your care team about new symptoms, such as fever, breathlessness, or swelling.
• Keep your mouth and teeth clean, and see a dentist regularly.
• Ask your care team before starting new medicines, supplements, or herbal products.

Medical treatments

Treatment usually involves a long course of medicines that fight germs. These are often given into a vein in hospital for part or all of the course. Your care team will choose the type based on tests and will watch for side effects. They may also give support for the heart, such as medicines to help the heart pump or to remove extra fluid. If the infection damages a valve, surgery may be needed.

When is surgery considered?

Surgery may be needed if a valve is badly damaged, if heart failure develops, if infection does not clear with medicine, or if clumps of infection or abscesses form. The care team will discuss the risks and benefits with you.

Living with this condition

Recovery can take weeks to months. You may feel tired for a while, and your care team will check your heart and blood tests. Follow-up is important even when you feel well, because valve damage or infection can sometimes show up later.

Lifestyle tips

• Build strength slowly and rest when your body tells you to.
• Avoid smoking and ask for help to stop if you smoke.
• Limit alcohol as advised by your care team.
• Keep good dental hygiene and regular dental check-ups.
• If you use drugs, seek non-judgmental support and harm-reduction services — this can lower your risk.
• Tell any healthcare professional that you have had endocarditis.

Diet and exercise

Eat regular balanced meals to support healing. Your care team may give specific advice if you have heart failure or kidney problems. Ask when it is safe to return to exercise. Many people start with short walks and slowly do more. Avoid heavy lifting or intense exercise until your doctor says it is okay.

Mental health and emotional wellbeing

A serious infection and a hospital stay can feel frightening or overwhelming. It is common to feel anxious, low, or worried about your heart. Talk to your care team if these feelings affect your daily life. If you ever have thoughts of harming yourself, call your local emergency number or a crisis support service right away.

Prevention

Not every case can be prevented, but you can lower your risk. Keep your teeth and gums healthy, get infections treated, avoid sharing needles, and care for skin wounds. If you have a high-risk heart condition, ask your care team whether you need extra steps before dental or medical procedures.

Vaccines

There is no vaccine that prevents endocarditis itself. Stay up to date with vaccines your care team recommends for your general health.

Screening programmes

There is no routine screening test for endocarditis in people without symptoms. If you have a heart condition, regular heart check-ups can help your team manage your risk.

Complications

If left untreated

• Damage to heart valves, which can lead to heart failure
• Infection spreading to other parts of the body
• Clumps of infection traveling to the brain and causing a stroke
• Abscesses — pockets of infection — around the heart
• Kidney problems or other organ damage
• Sepsis, a severe whole-body reaction to infection
• Death, if the infection is not treated

Long-term outlook

With prompt treatment, many people recover from endocarditis. Some need surgery or a longer recovery. Follow-up care makes a real difference. If you are being treated, keep in close touch with your care team and tell them about any new symptoms.

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