Heart Conditions Endocarditis

Overview

Endocarditis (say: en-doh-kar-DY-tis) is an infection of the thin lining inside the heart, most often the heart valves. Heart valves are the flaps that open and close to keep blood flowing the right way. When germs — usually bacteria — get into the bloodstream, they can settle on a valve and grow. This causes swelling and can damage the valve. Endocarditis is not a common illness, but it is serious and needs treatment in hospital. With quick care, most people recover well.

It is uncommon — roughly a few cases per 100,000 people each year in many countries. Because it is rare, doctors may not think of it straight away, which is why knowing the warning signs helps.

It can affect anyone at any age, but it is more likely in people who already have a heart valve problem or an artificial valve, people who inject drugs, people with long-term medical lines or on dialysis, and older adults. It is rare in healthy children, though it can happen in children with certain heart conditions.

Symptoms

Common symptoms

• A fever that keeps coming back, often with chills or sweating, especially at night
• Feeling very tired, weak, or generally unwell for days or weeks
• Shortness of breath, especially with activity
• A new or changed heart murmur (an extra sound your doctor hears through a stethoscope)
• Aching joints or muscles
• Losing weight without trying, or loss of appetite
• Small red or purple spots on the skin, or tiny streaks under the fingernails
• Pale skin or looking unwell

Symptoms in children

• A fever that will not settle, with poor feeding in babies
• Being unusually sleepy, floppy, or hard to wake
• Fast breathing or trouble feeding
• Not gaining weight or growing as expected

Symptoms in older adults

• Confusion or new forgetfulness, which can be the main sign
• Feeling generally unwell with a low-grade fever, or sometimes no fever at all
• Tiredness and breathlessness that get put down to 'just getting older'
• Weight loss and loss of appetite

Causes

Main causes

• Bacteria getting into the bloodstream and settling on a heart valve. Common sources include the mouth and gums (especially after dental work or with gum disease), the skin, the gut, the urinary tract, and long-term medical lines or tubes.
• Infections elsewhere in the body that spread through the blood.
• Using unsterile needles to inject drugs, which can push bacteria straight into the blood.
• Less often, fungi or other germs cause endocarditis, usually in people with a weakened immune system.

Risk factors

• An artificial (mechanical or tissue) heart valve, or a valve that has been repaired
• Previous endocarditis
• A heart valve that is damaged or narrowed, including from rheumatic heart disease
• Some congenital heart conditions (heart problems present from birth)
• Injecting drugs with unsterile needles
• Long-term use of a central line or catheter, or being on dialysis
• A weakened immune system, for example from certain illnesses or treatments
• Poor dental hygiene or gum disease
• Older age and some long-term health conditions

When to see a doctor

See a doctor urgently if:

• You have a heart valve problem or an artificial valve and you develop a fever — contact your doctor or local health service the same day
• A fever with no clear cause that lasts more than a few days, especially with feeling very tired or breathless
• New breathlessness, night sweats, or unexplained weight loss
• Your doctor has told you that you have a heart murmur and you now feel unwell with a fever

Book a routine appointment if:

• You have a heart valve condition and want to understand your risk and what to do if you get a fever
• You are due for a dental check-up or dental treatment and have an artificial valve or previous endocarditis
• You feel more tired than usual during everyday activities and want it checked
• You have questions about antibiotics before a procedure

Diagnosis

There is no single simple test. Your doctor will ask about your symptoms, examine you, and listen to your heart. If endocarditis is suspected, you will usually be referred to hospital quickly for blood tests and a heart scan. Doctors use a combination of findings — sometimes called the Duke criteria — to decide how likely the diagnosis is.

Tests that may be done

• Blood tests, including blood cultures. Blood cultures are the key test: they look for germs growing in your blood and help doctors choose the right antibiotic.
• Echocardiogram — an ultrasound scan of the heart that shows the valves and can spot growths (vegetations) on them. Sometimes a special scan is done down the food pipe (transoesophageal echo) for a clearer picture.
• An electrocardiogram (ECG), which records the heart's electrical rhythm.
• Urine tests and a chest X-ray.
• Other scans, such as a CT or MRI scan, if doctors need to look for infection elsewhere.

What to expect at your appointment

You will likely be seen in hospital the same day if endocarditis is suspected. Blood samples are usually taken before antibiotics are started, so the germs can be identified. You may have several blood tests over a day or two. The heart scan is painless and takes about 30 to 45 minutes. Waiting for results can feel anxious — ask the team to explain each step as it happens.

Treatment

Endocarditis is treated in hospital. The main treatment is antibiotics given through a drip into a vein, usually for several weeks. Some people need surgery to repair or replace a damaged valve. The team will include doctors, nurses, and often a heart specialist (cardiologist) and an infection specialist.

Self-care at home

• Take all medicines exactly as prescribed, even when you start to feel better — stopping early can let the infection come back.
• Rest and give yourself time. Recovery can take weeks, and feeling tired is normal.
• Keep your follow-up appointments, including blood tests and heart scans.
• Look after your teeth and gums, and tell your dentist about your heart condition.
• Tell any doctor, dentist, or nurse treating you that you have had endocarditis.
• Avoid smoking and limit alcohol, as these put extra strain on your heart.
• Ask for help with everyday tasks while you recover — accepting support helps recovery.

Medical treatments

Antibiotics given into a vein are the main treatment, usually in hospital for at least part of the course and sometimes continuing at home with support. The choice and length of treatment depend on which germ is found and how ill you are — this is decided by your medical team. You may also be given fluids, pain relief, and treatment for any other source of infection, such as dental problems. Sometimes a small tube (cannula) or line is placed in a vein for the medicine; the team will explain how to care for it if you continue treatment at home.

When is surgery considered?

Surgery may be suggested if a valve is badly damaged and the heart is struggling to pump, if the infection does not clear with antibiotics, or if there are signs the infection is spreading around the valve. The operation repairs or replaces the damaged valve. Your heart team will discuss the risks and benefits with you and your family, and it is always your choice to ask questions before deciding.

Living with this condition

After treatment, you will usually have follow-up appointments for a while, including repeat blood tests and a heart scan. Many people return to normal activities over weeks to a few months. Tiredness is common at first — build activity back up gradually. If you had surgery, your team will give you specific advice about lifting, driving, and returning to work.

Lifestyle tips

• Brush your teeth twice a day and clean between your teeth, and see a dentist regularly.
• Tell every health professional you see that you have had endocarditis or have a valve problem.
• Stop smoking if you can; ask your doctor or pharmacist for support.
• Keep alcohol within recommended limits.
• Stay physically active as you recover, building up slowly.
• Keep other health conditions, such as diabetes, well managed.
• Carry any card or note your hospital gives you about your heart condition.

Diet and exercise

Eat a balanced diet with plenty of vegetables, fruit, whole grains, and lean protein, and go easy on very salty and highly processed foods — this helps your heart and blood pressure. Once you feel ready, gentle exercise such as walking, swimming, or cycling is good for your heart. Ask your team when it is safe to start and how much to do. Build up gradually and stop if you feel chest pain, severe breathlessness, or dizzy.

Mental health and emotional wellbeing

It is very common to feel anxious or low after a serious infection or heart treatment. You may worry about your heart, about the infection coming back, or about returning to normal life. These feelings usually ease, but if they persist or affect your sleep, appetite, or daily life, please tell your doctor. Talking therapies and support groups can help a lot. If you ever feel you cannot cope or have thoughts of harming yourself, contact your local emergency number or a crisis line in your country straight away — you deserve support.

Prevention

It cannot always be prevented, but you can lower your risk. The most important steps are good dental care, prompt treatment of infections, and safe practice if you use needles. If you have a high-risk heart condition, your doctor or dentist may recommend a short course of antibiotics before certain dental or medical procedures. This is not needed for most people — ask your own team whether it applies to you.

Vaccines

Keep up to date with routine vaccinations recommended in your country. Some vaccines, such as flu and pneumonia vaccines, are offered to people with heart conditions because infections can be more serious for them. Ask your doctor or pharmacist which ones are right for you.

Screening programmes

There is no general screening test for endocarditis. What helps is regular dental check-ups, and making sure your doctor knows about any heart valve problem so they can act quickly if you become unwell with a fever.

Complications

If left untreated

• Damage to the heart valve, which can lead to heart failure (the heart struggling to pump blood around the body)
• Clots or clumps of infection breaking off and travelling in the blood, which can cause a stroke or block blood vessels elsewhere
• A collection of pus (abscess) around the valve or in the heart
• Kidney problems or other organ damage
• A severe whole-body infection that becomes life-threatening

Long-term outlook

With prompt treatment, most people recover and return to their usual lives. Many need a few weeks of antibiotics; some need surgery on a valve. Recovery can be gradual, and tiredness for a while afterwards is normal. Regular follow-up helps your team catch any problems early. If you have ongoing heart valve issues, your team will keep an eye on you and adjust your care as needed.

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