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What is endocarditis?

Endocarditis is an infection of the inner lining (endocardium) of your heart.

What causes endocarditis?

Endocarditis typically occurs when bacteria or other germs from another part of your body, such as your mouth, spread through your bloodstream and attach to damaged areas in your heart. Bacteria cause most cases, although fungi or other microorganisms also may be responsible. The offending organism may enter your bloodstream a number of different ways, including: everyday oral activities such as brushing your teeth or chewing food; certain dental procedures, an infection or other medical condition; or catheters or needles.

What are the common symptoms of endocarditis?

Endocarditis may develop suddenly or slowly, depending on the cause of the infection and whether you have any underlying heart problems. The infection can strike different people in different ways, thus signs and symptoms vary.

They may include: fever; blood in your urine; chills; a new or changed heart murmur — abnormal heart sounds made by blood rushing through your heart; fatigue; aching joints and muscles; shortness of breath; paleness; persistent cough; swelling in your feet, legs or abdomen; tenderness in your spleen; night sweats; red, tender spots under the skin of your fingers; unexplained weight loss; and tiny purple or red spots on the skin, whites of your eyes or inside your mouth.

Is endocarditis dangerous?

Endocarditis can damage or destroy your heart valves and can lead to life-threatening complications if left untreated.

What factors increase your risk of endocarditis?

Endocarditis is uncommon in people with healthy hearts. Most of those who develop endocarditis have a diseased or damaged heart valve — an ideal spot for bacteria to settle. This damaged tissue in the endocardium provides bacteria with a roughened surface to which the bacteria can attach and multiply. Germs are more likely to attach to an artificial (prosthetic) heart valve than to a normal heart valve. Other risk factors include: congenital heart defects; a history of endocarditis; or a history of intravenous (IV) illegal drug use.

How is the source of my endocarditis detected?

Blood tests may prove useful in identifying the type of microorganism that is infecting your heart.

How is endocarditis treated?

Treatments for endocarditis include antibiotics and, in the more severe cases, surgery. Treatment has three main goals: to destroy the infection quickly; if needed, to repair or replace a heart valve; and treatment of endocarditis-related complications. You will need several weeks of treatment with one or more antibiotics if you have endocarditis. Initially, you will be treated in the hospital because the necessary antibiotics must be given through a vein (by IV); furthermore, additional test may be required during the treatment.

After your fever is gone and you are stable, you may be able to return home to continue IV antibiotics with the help of a home health nurse.  The antibiotics must be given for a long enough period of time and at a strong enough doses to destroy all of the bacteria. After the first IV antibiotics, your doctor may want you follow up with antibiotic pills. If endocarditis is caused by a fungus, you may need an intravenous antifungal medicine.

Usually when endocarditis is caused by a fungus, heart valve surgery is required. If your heart valve becomes severely damaged from endocarditis or if you develop an infection in an artificial heart valve, you may need surgery to repair or replace that valve.

How can I prevent endocarditis?

To help prevent endocarditis, make sure to practice good hygiene. Pay special attention to your dental health. Avoid procedures that may lead to skin infections, including body piercings or tattoos. If you develop any type of skin infection or open cuts or sores that don’t heal properly, seek prompt medical attention.

People with the following heart conditions are at risk of certain serious outcomes from endocarditis, and may need to take preventive antibiotics before certain medical or dental procedures to prevent its occurrence: a previous endocarditis infection; an artificial (prosthetic) heart valve; a heart transplant complicated by heart-valve problems; and certain types of congenital heart defects.

Because certain dental and medical procedures may allow bacteria to enter your bloodstream, preventative antibiotics taken before these procedures can help destroy or control the harmful bacteria that could lead to endocarditis. Antibiotics are recommended only before the following procedures: certain dental procedures (those that cut your gum tissue or part of the teeth); and procedures involving infected skin or tissue that connects muscle to bone, and the respiratory tract.

Antibiotics are no longer recommended across the board before all dental procedures or for procedures of the urinary tract or gastrointestinal system. If you’ve had to take preventive antibiotics in the past before your dental exams, you may be concerned about these changes. In the past, you were likely told to get antibiotics because of a concern that common dental procedures increased your risk of endocarditis. But as doctors have learned more about endocarditis prevention, they’ve realized that endocarditis is much more likely to occur from exposure to random germs than from a typical dental exam or surgery.

Is endocarditis a common condition?

Endocarditis is more common in older people. About 50% of all cases occur in patients over the age of 50. Endocarditis is twice as common in men of any age and is 8 times as common in elderly men as in elderly women. In children and young adults, most cases (about 75%) of endocarditis occur in those with congenital (i.e., present at birth) heart defects.

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