Pronounced: En-doh-kar-dite-iss

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by Rosalyn Carson-DeWitt, MD

Definition

Endocarditis is an infection of the heart valves and the endocardium. The endocardium is the inner lining of the heart muscle.

Causes

Causes include:

• Bacterial infection (most common cause)
• Viral or fungal infection
• Medical conditions that result in blood clotting too easily (This causes a noninfectious form.)

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Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

• An artificial heart valve
• History of endocarditis
• History of rheumatic fever, which can damage heart valves
• Heart defects
• Enlarged heart
• Mitral valve prolapse
• History of IV drug use
• Recent procedures that can lead to bacterial endocarditis, including:
• Tooth cleaning
• Tonsillectomy and adenoidectomy
• Bronchoscopy
• Surgery on the gastrointestinal, urinary, or respiratory tracts
• Gallbladder or prostate surgery

Symptoms

Symptoms include:

• Fever, chills
• Weakness, low energy
• Sweatiness, especially at night
• Shortness of breath
• Cough
• Loss of appetite, weight loss
• Chest pain
• Abdominal pain
• Nausea and vomiting
• Painful red bumps on the fingers and toes
• Purple dots on the whites of the eyes, under the fingernails, and over the collarbone
• Painful red patches on the fingers, palms, and soles

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. The doctor will check your heart for unusual heart sounds (called murmurs).

Tests include:

• Blood tests—to check for infection
• Echocardiogram—uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart

Treatment

Treatment may include:

• Antibiotics—given through your veins for up to 4-8 weeks
• Surgery—to repair or replace the valve if it is severely damaged

Prevention

If you are at risk for endocarditis during certain dental or medical procedures, be sure to speak with your dentist or doctor about your need to take antibiotics before the procedure.

According to recent American Heart Association guidelines, individuals with the following cardiac conditions are at the highest risk of an adverse outcome from endocarditis and should be considered for preventive antibiotic therapy:*

• Various forms of congenital heart disease (heart defects)
• Artificial heart valves
• History of endocarditis
• Heart transplant recipients who have developed valve disease

To further prevent this condition, never use illegal intravenous drugs.

RESOURCES:
American Heart Association
http://www.americanheart.org

Heart Information Network
http://www.heartinfo.org

CANADIAN RESOURCES:
Heart and Stroke Foundation of Canada
http://ww2.heartandstroke.ca/Page.asp?Pa...

University of Ottawa Heart Institute
http://www.ottawaheart.ca/UOHI/Welcome.d...

REFERENCES:

Braunwald E, Zipes DP, Libby P, et al. Heart Disease: A Textbook of Cardiovascular Medicine. 6th ed. Philadelphia, PA: WB Saunders Company; 2001.

Cecil RL, Goldman L, Bennett JC. Cecil Textbook of Medicine. 21st ed. Philadelphia, PA: WB Saunders Company; 2000.

Rakel RE and Bope ET. Conn's Current Therapy 2001. 53rd ed. Philadelphia, PA: WB Saunders Company; 2001.

*Updated Prevention section on 5/16/2007 according to the following study, as cited byhttp://www.ebscohost.com/dynamed/what.php: Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis. Guidelines from the American Heart Association. Circulation. 2007 Apr 19. [Epub ahead of print]

Last reviewed December 2007 by J. Peter Oettgen, MD

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Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.