Endocarditis awareness

Overview

Endocarditis (en-doe-kar-DYE-tis) is a rare but serious infection of the inner lining of your heart, especially the heart valves. It happens when germs, usually bacteria, enter your bloodstream and settle in your heart.

No, endocarditis is not common. It affects about 3 to 10 people per 100,000 each year.

It can happen to anyone, but you are at higher risk if you have a heart valve problem, an artificial heart valve, a previous history of endocarditis, a congenital heart defect (heart problem from birth), or if you inject recreational drugs. People with poor dental health or who have had certain dental procedures may also be at higher risk.

Symptoms

Common symptoms

• Fever and chills
• Night sweats
• Feeling very tired (fatigue)
• Shortness of breath, especially with activity
• A new or changed heart murmur (an extra sound your doctor hears when listening to your heart)
• Unexplained weight loss
• Muscle aches or joint pain

Symptoms in children

• Fever and chills (same as adults)
• Poor feeding or loss of appetite
• Irritability or fussiness
• Trouble breathing
• Swelling in the legs or belly (fluid buildup)

Symptoms in older adults

• Confusion or mental changes
• Weakness or dizziness
• Loss of appetite
• Unexplained falls
• Sometimes milder fever, so symptoms may be less obvious

Causes

Main causes

• Bacteria (most commonly from your mouth, skin, or gut) entering your bloodstream and attaching to damaged areas of your heart valves or lining.
• Less often, fungi can cause endocarditis, especially in people with weakened immune systems or after heart surgery.

Risk factors

• Having a damaged or artificial heart valve
• Having had endocarditis before
• Being born with a heart defect (congenital heart disease)
• Injecting recreational drugs using dirty needles
• Having poor dental health or gum disease
• Having a long-term intravenous (IV) line for medical treatment
• Having a condition that weakens your immune system

When to see a doctor

See a doctor urgently if:

• If you have a fever and chills that do not go away, especially if you have a known heart condition or other risk factors.
• If you notice new shortness of breath, chest pain, or signs of a stroke (weakness on one side, trouble speaking).
• If you have sudden confusion or feel very weak.

Book a routine appointment if:

• If you have a low-grade fever, night sweats, or fatigue that lasts more than a week without a clear cause.
• If you notice new or worsening heart murmur during a check-up.

Diagnosis

Your doctor will start by asking about your symptoms and your medical history, and they will listen to your heart with a stethoscope. If they suspect endocarditis, they will order several tests to confirm the diagnosis.

Tests that may be done

• Blood cultures: blood samples are taken to find out what germ is causing the infection.
• Echocardiogram: an ultrasound of your heart to look for growths (called vegetations) on your valves or other signs of infection.
• Transesophageal echocardiogram (TOE): a more detailed ultrasound done with a small probe passed down your throat.
• Other tests: complete blood count, CRP or ESR (markers of inflammation), and sometimes a CT scan or MRI.

What to expect at your appointment

If endocarditis is suspected, you will likely be admitted to hospital. You will have blood cultures taken and an echocardiogram. The diagnosis can take a few days as cultures need time to grow. While waiting, you may be started on intravenous (IV) antibiotics. The team looking after you will include heart specialists (cardiologists) and infection specialists.

Treatment

Endocarditis is treated in hospital, usually with a long course of antibiotics given through a vein (IV). Treatment can last for several weeks. In some cases, surgery is needed to repair or replace damaged heart valves. You will be closely monitored throughout.

Self-care at home

• Follow your treatment plan exactly as prescribed — do not miss doses of your antibiotics.
• Get plenty of rest during treatment and recovery.
• Keep your mouth clean by brushing gently with a soft toothbrush and rinsing regularly to prevent new infections.
• Tell your healthcare team about any new symptoms, such as fever, chills, or chest pain.

Medical treatments

Antibiotics: You will receive antibiotics through a vein (intravenous) for 4 to 6 weeks. The exact antibiotic depends on the type of bacteria found. You may need to have a special line (like a PICC line) placed so you can go home with IV antibiotics if your condition is stable. Steroids or anti-inflammatory medicines are sometimes used to control inflammation, but only under close medical supervision.

When is surgery considered?

Surgery may be needed if: the infection damages a heart valve severely, causing leakage (regurgitation); an abscess forms in the heart; the infection is caused by a very resistant germ; or if large vegetations break off and cause a stroke. Surgery involves repairing or replacing the affected valve.

Living with this condition

Recovery from endocarditis takes time. You may feel tired for weeks or months after treatment ends. You will need regular follow-up appointments with a cardiologist, including repeat echocardiograms to check your heart. Notify your doctor immediately if you get any new fever or symptoms.

Lifestyle tips

• Take good care of your teeth and gums — brush twice a day, floss gently, and see a dentist regularly. Let your dentist know you have had endocarditis.
• Avoid intravenous drug use. If you need help stopping, talk to your healthcare provider about support services.
• Avoid tattoos and piercings if possible, as they can introduce bacteria into your bloodstream.

Diet and exercise

Eat a balanced diet rich in fruits, vegetables, whole grains, and lean protein to support your immune system. Light activity like walking can help you regain strength, but ask your doctor when it is safe to increase exercise. Avoid heavy lifting or strenuous activity until your heart function is stable.

Mental health and emotional wellbeing

Being diagnosed with a serious heart infection can be frightening and stressful. You may feel anxious, depressed, or worried about your health. It is normal to have these feelings. Talk to your doctor or a counsellor if you need support. Connecting with others who have had a similar experience can also help.

Prevention

For most people, good oral hygiene and dental care are the best ways to prevent endocarditis. If you are at high risk (e.g., artificial valve, previous endocarditis, certain congenital heart diseases), your doctor may recommend antibiotics before certain dental procedures or surgeries. Never take antibiotics for prevention without a prescription.

Vaccines

There is no vaccine for endocarditis itself. However, keeping up to date with vaccines like the flu vaccine and pneumococcal vaccine can help prevent infections that might lead to endocarditis.

Screening programmes

Screening is not routine for the general public. If you have a heart condition that puts you at risk, your doctor will monitor your heart regularly with echocardiograms and check for any signs of infection.

Complications

If left untreated

• Heart failure: the infection can weaken your heart and cause fluid buildup in your lungs.
• Stroke: pieces of the infection (vegetations) can break off and travel to your brain.
• Septic shock: the infection can spread throughout your body, causing dangerously low blood pressure and organ failure.
• Abscesses: pockets of pus can form in your heart or other organs like the lungs, brain, or spleen.
• Damage to the heart valves that may need surgery to repair.

Long-term outlook

With prompt diagnosis and proper treatment in hospital, most people recover from endocarditis. However, it is a serious condition that requires close monitoring. Even after successful treatment, you will need long-term follow-up to make sure your heart stays healthy. The outlook depends on factors like your age, overall health, and how quickly treatment began. Stick with your treatment plan and follow-ups to give yourself the best chance of a full recovery.

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