Quickly or slowly
It can develop quickly or slowly, and if not treated, it can be fatal. Endocarditis is an infection of the inner lining of the heart, known as the endocardium. Certain forms of bacteria live on your skin your intestines and your urinary tract. And sometimes, bacteria and other germs may enter your bloodstream during surgery or a dental procedure. This is called bacteremia. A brief bacteremia is common after many routine activities, like tooth brushing and flossing. When harmful bacteria settle on abnormal heart valves or damaged heart tissue, they can damage or even destroy the heart valves. The valves are necessary to guide the flow of blood through the heart. They work like doors to keep the blood flowing in a certain direction. If they become damaged, the results could be very serious. Endocarditis is rare in people with healthy hearts. Those at risk for the infection include people with damaged heart valves, artificial heart valves or other heart defects.
In the bloodstream
Endocarditis occurs when germs enter your bloodstream, travel to your heart, and attach to abnormal heart valves or damaged heart tissue. Sometimes the culprit is one of many common bacteria that live in your mouth, throat or other parts of your body. The offending organism may enter your bloodstream through activities like brushing your teeth or chewing food, especially if your teeth and gums aren’t healthy. Gum disease, a sexually transmitted infection or an intestinal disorder, such as inflammatory bowel disease, may also give bacteria the opportunity to enter your bloodstream. Some dental procedures that can cut your gums may allow bacteria to enter your bloodstream. The bacteria that can cause endocarditis can also enter the body through the needles used for tattooing or body piercing. Usually, your immune system destroys bacteria that make it into your body. Even if bacteria reach your heart, they may pass through without causing an infection.
Risks for infection
Most people 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 the roughened surface they need to attach and multiply. If you have an artificial heart valve or a congenital heart defect, your heart may be more susceptible to the infection. People who use illegal drugs are at risk because the needles used to inject drugs can be contaminated with the bacteria that can cause the infection. If you have a heart defect or heart valve problem, be sure to ask your doctor about your risk of developing endocarditis. Left untreated, it can damage your heart valves and permanently destroy your heart’s inner lining. This can cause your heart to work harder to pump blood, eventually causing heart failure, a chronic condition in which the heart is unable to pump enough blood to meet the body’s needs. If the infection progresses untreated, it’s usually fatal.
See physician right away
The symptoms of endocarditis, an infection of the inner lining of the heart, can vary from person to person. They can develop slowly or quickly, depending on what’s causing the infection and the patient’s history of heart problems. Fever and chills, night sweats, shortness of breath and a persistent cough are a few of the signs. Swelling in the feet, legs or abdomen, blood in the patient’s urine and an unexplained weight loss are other possible symptoms of endocarditis. If you have any of these problems, see your physician right away, especially if you have a known heart defect. Certain tests are necessary to make a correct diagnosis. The most important test is a blood culture used to identify bacteria in the bloodstream. Blood tests can also help your doctor identify certain conditions, including anemia, a shortage of healthy red blood cells that can be a sign of endocarditis. An electrocardiogram or chest X-ray may be necessary to see if the infection has spread.
Treated with antibiotics
Patients with endocarditis are typically given high doses of intravenous antibiotics in the hospital for two to six weeks or longer to clear up the infection. Once their fever and the worst of their symptoms have passed, they may be able to leave the hospital and continue IV antibiotic therapy with visits to a doctor’s office or at home with home-based care. Sometimes surgery is needed to treat persistent infections or to replace a damaged valve. Surgery is also sometimes needed to treat endocarditis that’s caused by a fungal infection. Depending on the patient’s condition, the physician may recommend either repairing the damaged valve or replacing it with an artificial valve made of animal tissue or man-made materials. If you’re at risk of endocarditis, let all of your health care providers know. You may want to request an endocarditis wallet card from the American Heart Association. Check with your local chapter or you can print the card from the association’s website.
Trusted by thousands of listeners every week, T. Glenn Pait, M.D., began offering expert advice as the host of UAMS’ “Here’s to Your Health” program in 1996. Dr. Pait began working at UAMS in 1994 and has been practicing medicine for over 20 years.