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

Alternative Names

Valve infection

Causes, incidence, and risk factors

Endocarditis can involve the heart muscle , heart valves, or lining of the heart. Most people who develop endocarditis have underlying valvular heart disease . Injection drug use, recent dental surgery, permanent central venous access lines, prior valve surgery, and weakened valves are risk factors for developing endocarditis. Bacterial infection is the most common source of endocarditis. However, it can also be caused by fungi. In some cases, no causative organism can be identified. Related topics:

culture-negative endocarditis

infective endocarditis

Signs and tests

A history of congenital heart disease , rheumatic fever, recent dental work, or intravenous drug use raises the index of suspicion. Physical examination may show an enlarged spleen ( splenomegaly ). The examiner may detect a new heart murmur, or a change in a previous heart murmur. Examination of the nails may show splinter hemorrhages . Eye examination may show retinal hemorrhages with a central area of clearing (called Roth's spots), and petechiae (small pinpoint hemorrhages) may be detected in the conjunctiva. The fingertips may become enlarged and the nails may curve (clubbing). Tests:

repeated

blood culture and sensitivity (best test for detection)

serology for certain bacteria that may be hard to detect by blood culture

ESR

(erythrocyte sedimentation rate)

CBC

may show a high white count and/or low grade, microcytic (small red blood cells)

anemia

ECG

echocardiogram

transesophageal echocardiogram

chest X-ray

Treatment

Hospitalization is often required initially to treat administer

intravenous antibiotics. Long-term antibiotic therapy is required to eradicate the bacteria from the heart chambers and vegetations on the valves. Therapy up to 6 weeks is not uncommon. The chosen antibiotic must be specific for the organism causing the condition. This is determined by the blood culture and the sensitivity tests. Activity is restricted to bed rest initially, then it is gradually increased as the condition improves. No special diet (such as a low-salt diet) is necessary, unless it is required because of an underlying heart disorder. If heart failure develops as a result of damaged heart valves, or if the infection is breaking off in little pieces resulting in a series of strokes, surgery to replace the affected heart valve may be indicated.

Expectations (prognosis)

Early treatment of endocarditis improves the chances of a good outcome.

Complications

congestive heart failure

if treatment is delayed

blood clots

or

emboli that travel to brain, kidneys, lungs, or abdomen, causing severe damage to these organs

arrhythmias

(rapid or

irregular heartbeat ), such as atrial fibrillation

glomerulonephritis

severe heart valve damage

stroke

brain abscess

brain or nervous system changes

jaundice

Calling your health care provider

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

weight loss

without change in diet

blood in urine

chest pain

weakness

fatigue

numbness

fever

Prevention

Preventive (prophylactic) antibiotics are often given to people with predisposing heart conditions before dental procedures or surgeries involving the

respiratory , urinary, or intestinal tract. Continued medical follow-up is advised for people with a previous history of endocarditis.