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Infective endocarditis is a serious infection of the endocardium (the smooth interior lining of the heart ) and/or the heart valves. Although several different types of organisms can cause endocarditis, it is usually caused by a bacterial infection. Endocarditis occurs when bacteria in the bloodstream "take up residence" and begin to grow and multiply on the heart valve. Contrary to what the name might suggest, "infective" endocarditis is not in fact contagious.
There are four one-way heart valves that allow blood to be pumped forward from one chamber to another and throughout the body. At the same time these valves prevent blood from backing up into other chambers and the lungs.
Infective endocarditis may be acute or sub-acute. It can come on suddenly and become life-threatening within a matter of days, in which case it is called acute infective endocarditis. Subacute endocarditis usually develops gradually and subtly over a period of weeks to several months.
Causes & Development; Risk Factors
The vast majority of cases of endocarditis are caused by a bacterial infection. Heart valves that have previously been damaged in some way or are dysfunctional are believed to be more prone to develop infections, though infection can also occur on a perfectly normal heart valve.
There are numerous ways that bacteria can get into the bloodstream to cause infection of the heart valve. Something as minor as a small cut can enable bacteria that normally live on the skin to get into the bloodstream. In some cases, this can occur during a dental procedure. In hospitalized patients, the IVs and catheters that are often inserted into the veins may be the portal through which bacteria get into the blood. For many endocarditis patients, however, no clear explanation is ever found regarding how the bacteria first got into the bloodstream.
Fungal infection is a rare cause of endocarditis. This occurs most commonly in patients with compromised immune systems, such as those with AIDS or those who have undergone chemotherapy.
The most common cause - a bacterial infection - may present in two ways:- Acute bacterial endocarditis (ABE), mainly caused by staphylococci, streptococci, pneumococci or gonococci.
- The Subacute (SBE) illness, mostly caused by other streptococci or haemophilus bacteria.
Risk of endocarditis increases with:- Rheumatic fever or rheumatic heart disease
- Congenital heart disease
- Injections of contaminated materials into the bloodstream, such as with self-administered intravenous drugs
- Invasive procedures such as cardiac catheterizations, intravenous lines and catheters etc.
- Pregnancy
- Excess alcohol consumption
- Artificial heart valves
- Use of immunosuppressive drugs
- Mitral valve prolapse
- Minor surgical procedures, such as dental work, in susceptible individuals
Signs & Symptoms
Endocarditis can cause a wide variety of symptoms, particularly in the earlier stages of infection. Patients may experience such general symptoms as fevers, chills, fatigue, weight loss, muscle aches, and sweating. These general, nonspecific, symptoms can make it hard both for the patient and the doctor to recognize endocarditis.
As infection progresses, other symptoms may develop. If the infection begins to damage the heart valve, the valve may become "leaky." A leaky heart valve can eventually lead to blood backing up into the lungs. This accumulation of fluid in the lungs can cause shortness of breath. If the infection spreads to the kidneys, patients may notice blood in the urine. If the infection spreads to the brain, it can cause headaches, confusion, or even stroke.
Subacute bacterial endocarditis (SBE) has an insidious onset and may have some or all of all of the following symptoms:- Intermittent low-grade fever, chills and excessive sweating, especially at night
- Fatigue and weakness
- Vague aches and joint pains. Back pain, may be severe
- Heart murmur
- Weight loss
- Late stages:
- Severe chills and high fever
- Shortness of breath on exertion
- Swelling of the feet, legs and abdomen
- Rapid or irregular heartbeat
Acute bacterial endocarditis (ABE) has similar symptoms, but the course is much more rapid.
Diagnosis & Tests
A physician may suspect endocarditis based on symptoms alone, especially in a patient with a predisposing condition. Patients suspected of having acute bacterial endocarditis are usually hospitalized promptly for diagnosis and treatment. Diagnostic tests may include laboratory blood counts and blood cultures, electrocardiogram, X-rays of the heart and lungs, including echocardiogram.
In some 5 to 10% of cases, fungal infection or some rare bacteria may be the cause of endocarditis and in this group the blood cultures are negative.
Treatment & Prevention
The goal of treatment is to eradicate the infecting organism with medications and supportive care for relieving symptoms, with hospital care during the acute phase. Once stable, some patients can continue with treatment at home. Surgery may be used to replace infected valve in patients in whom antibiotics have not been effective or in patients with artificial heart valves, or in patients with dramatically worsening symptoms.
Prognosis; Complications
The disease is usually curable with early diagnosis and treatment, but recovery may take weeks. If treatment is delayed, heart function deteriorates, resulting in congestive heart failure and possible death.
Left untreated, this bacterial infection can gradually "eat away" at and damage the heart valve, causing it to malfunction. It is always fatal if untreated.
Possible complications include: Infected blood clots that may travel to the brain, kidneys, or abdominal organs causing infections, abscesses or stroke; heart-rhythm disturbances (atrial fibrillation is most common); destruction of heart valves; lung clots; arthritis; myositis (inflammation of muscles); acute renal failure.
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Conditions that suggest Endocarditis: | | | | | Infections |  Septicemia | Infection of the heart valve can spread through the bloodstream to other parts of the body, causing infection in the blood (septicemia) and in other parts of the body. |
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Risk factors for Endocarditis:
Recommendations and treatments for Endocarditis: | | | | | Dental |  Adequate Dental Care| | Part of prevention is to maintain good oral hygiene. |
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Drug |
 Antibiotics| | Antibiotics are required for several weeks to fight infection. Antibiotic treatment is often intravenous.
If you have heart valve damage or a heart murmur, request antibiotics prior to medical procedures that may introduce bacteria into the blood. These include dental work, childbirth and surgery of the urinary or gastrointestinal tract. |
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Physical Medicine |
Rest| | Rest in bed until you are fully recovered. While in bed, flex your legs often to prevent clots from forming in deep veins. Resume your normal activities, including sexual relations when strength allows. |
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KEY | | Weak or unproven link | | | May do some good | | | Likely to help |
GLOSSARY
Abdomen (Abdominal)
That part of the body between the chest and the hips that contains the stomach, intestines, liver, bladder, pancreas and other organs.
Acute
An illness or symptom of sudden onset, which generally has a short duration.
AIDS
Acquired Immune Deficiency Syndrome. An immune system deficiency disorder that suddenly alters the body's ability to defend itself. The AIDS virus invades the T4 helper/inducer lymphocytes and multiplies, causing a breakdown in the body's immune system, eventually leading to overwhelming infection and/or cancer, with ultimate death.
Arthritis (Arthritic)
Inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis. Osteoarthritis, the most common form, is characterized by a gradual loss of cartilage and often an overgrowth of bone at the joints.
Bacteria (Bacterial, Bacterium)
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Boil (Abscess, Abscesses, Boils, Carbuncle, Carbuncles, Cystic Acne, Furuncle, Furuncles, Hidradenitis Suppurativa, Pilonidal Cyst, Pilonidal Cysts)
A localized infection deep in the skin. A boil generally starts as a reddened, tender area. Over time, the area becomes firm and hard. Eventually, the center of the abscess softens and becomes filled with white cells that the body sends to fight the infection (pus). Finally, the pus forms a "head" and drains out through the skin. A furuncle or carbuncle is an abscess in the skin caused by the bacteria Staphylococcus aureus. It can have one or more openings onto the skin and may be associated with a fever or chills. Cystic acne is a type of abscess formed when oil ducts become clogged and infected. Cystic acne is most common in the teenage years. Hidradenitis suppurativa is an illness in which there are multiple abscesses that form under the arm pits and in the groin area. These areas are a result of local inflammation of the sweat glands. A pilonidal cyst is a special kind of abscess that occurs in the crease of the buttocks. These frequently form after long trips that involve sitting.
Cardiac
Pertaining to the heart, also, pertaining to the stomach area adjacent to the esophagus.
Chemotherapy
A treatment of disease by any chemicals. Used most often to refer to the chemical treatments used to combat cancer cells. Chemotherapy is usually given in cycles: a treatment period followed by a recovery period, then another treatment period, and so on. Most anticancer drugs are given by injection into a blood vessel (IV); some are given by mouth. Chemotherapy is a systemic therapy, meaning that the drugs enter the bloodstream and travel throughout the body. Usually, a patient has chemotherapy as an outpatient (at the hospital, at the doctor's office, or at home). However, depending on which drugs are given and the patient's general health, a short hospital stay may be needed.
Congestive
Pertaining to accumulation of blood or fluid within a vessel or organ.
Electrocardiogram (ECG, EKG)
A test that shows a tracing of the electrical conduction of the heart.
Gastrointestinal (GI, GI Tract)
Pertaining to the stomach, small and large intestines, colon, rectum, liver, pancreas, and gallbladder.
Insidious
A symptom or condition of gradual onset or development.
Kidneys (Kidney, Renal)
Bean-shaped organs, each about the size of a fist. They are located near the middle of the back, just below the rib cage. The kidneys are sophisticated reprocessing machines, each day handling about 50 gallons of blood to sift out about half a gallon of waste products and extra water. The waste and extra water become urine, which flows to the bladder through tubes called ureters. The actual filtering occurs in tiny units inside the kidneys called nephrons. Every kidney has about a million nephrons. In a nephron, a glomerulus -- which is a tiny blood vessel, or capillary -- intertwines with a tiny urine-collecting tube called a tubule. A complicated chemical exchange takes place, as waste materials and water leave your blood and enter your urinary system. The kidneys recycle chemicals such as sodium, phosphorus, and potassium and thus regulate their levels. Renal: Pertaining to the kidneys.
Lung (Lungs, Pulmonary)
Organ of the body, located in the chest cavity which is designed to bring oxygen from the air into the blood stream, while also expelling carbon dioxide and other waste gases out of the body. Pulmonary: Related to the lungs.
Sepsis (Blood Poisoning, Septicemia)
Like septicemia, an infection that has moved deeply into the body, involving the subcutaneous or submucosal layers, connective tissue, lymph system, or blood. Septicemia: The presence of pathogenic bacteria or other microbes in the blood stream - a serious business, since most defenses are focused outside the bloodstream and the infection has bypassed them either due to its virulence, the depth and severity of the original focal infection or the weakened state of the body's immunity and life energy. Blood poisoning.
Stroke (Stroke-Type Event)
A sudden loss of brain function caused by a blockage or rupture of a blood vessel that supplies the brain, characterized by loss of muscular control, complete or partial loss of sensation or consciousness, dizziness, slurred speech, or other symptoms that vary with the extent and severity of the damage to the brain. The most common manifestation is some degree of paralysis, but small strokes may occur without symptoms. Usually caused by arteriosclerosis, it often results in brain damage.
Subacute
Having characteristics of both acute and chronic. This is the state in a disease when most of the aches and pains have subsided and you are likely to overdo things and not completely recover. The chest cold that lingers for weeks as a stubborn cough is a subacute condition, as is the tendonitis that lingers because you won't stop playing tennis long enough to completely heal.
X-rays (X-ray)
High-energy radiation used to take pictures of areas inside the body.
Last updated: Mar 22, 2010
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