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A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M.; 2013.

A.D.A.M. Medical Encyclopedia.

Endocarditis

Valve infection; Staphylococcus aureus - endocarditis; Enterococcus - endocarditis; Streptococcus viridans - endocarditis; Candida - endocarditis

Last reviewed: July 16, 2012.

Endocarditis is inflammation of the inside lining of the heart chambers and heart valves (endocardium).

Causes, incidence, and risk factors

Endocarditis can involve the heart muscle, heart valves, or lining of the heart. Most people who develop endocarditis have a:

Endocarditis begins when different germs enter the bloodstream and then travel to the heart.

Germs are most likely to enter the bloodstream during:

Symptoms

Symptoms of endocarditis may develop slowly or suddenly.

Fever, chills, and sweating are the classic symptoms. These sometimes can:

  • Be present for days before any other symptoms appear
  • Come and go, or be more noticeable at nighttime

Fatigue, weakness, and aches and pains in the muscles or joints may also be present.

Other symptoms can include:

Signs and tests

The health care provider may detect a new heart murmur, or a change in a past heart murmur.

An eye exam may show bleeding in the retina and a central area of clearing. This is known as Roth's spots. There may be small, pinpoint areas of bleeding on the surface of the eye or the eyelids. 

Tests that may be done include:

Treatment

You may need to be hospitalized at first to receive antibiotics through a vein (IV or intravenously). Blood cultures and tests will help your health care provider choose the best antibiotic.

You will then need long-term antibiotic therapy.

  • Patients usually need therapy for 4-6 weeks to fully remove all the bacteria from the heart chambers and valves.
  • Antibiotic treatments that are started in the hospital will need to be continued at home.

Surgery to replace the heart valve is usually needed when:

  • The infection is breaking off in little pieces, resulting in strokes
  • The person develops heart failure as a result of damaged heart valves
  • There is evidence of more severe organ damage

Expectations (prognosis)

Getting treatment for endocarditis right away improves the chances of a good outcome.

More serious problems that may develop include:

Calling your health care provider

Call your health care provider if you notice the following symptoms during or after treatment:

Prevention

The American Heart Association recommends preventive antibiotics for people at risk for infectious endocarditis, such as those with:

These patients should receive antibiotics when they have:

  • Dental procedures that are likely to cause bleeding
  • Procedures involving the breathing tract
  • Procedures involving the urinary tract system
  • Procedures involving the digestive tract
  • Procedures on skin infections and soft tissue infections

 

References

  1. Fowler VG Jr, Scheld WM, Bayer AS. Endocarditis and Intravascular Infections. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009; chapt 77.
  2. Karchmer AW. Infective Endocarditis. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 67.
  3. Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007 Oct 9;116(15):1736-54. [PubMed: 17446442]

Review Date: 7/16/2012.

Reviewed by: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

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The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

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  • Heart, section through the middle.
    Heart, front view.
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