Endocarditis

Endocarditis symptoms may be severe or very mild. They may start suddenly or slowly. And they can vary from person to person. The possible symptoms of endocarditis include:

• Fever and chills
• Night sweats (heavy sweating during sleep)
• Chest pain
• Cough
• Shortness of breath (feeling like you can’t get enough air)
• Muscle, joint and back pain
• Skin changes, including:
  • Broken blood vessels
  • Painful red or purple bumps
  • Painless flat red spots on the palms of your hands or soles of your feet
• For slow developing cases, chronic fatigue, exercise intolerance, poor appetite and unexplained weight loss can occur. 

Call your healthcare provider right away if you have symptoms that could be endocarditis. 

Bacterial infections 

Bacterial infections cause most cases of endocarditis. Normally, many bacteria live in your mouth, on your skin or in other parts of the body. Sometimes the bacteria can get into your bloodstream from injuries such as cuts or scrapes. Dental work and certain surgeries can also allow small amounts of bacteria to enter your bloodstream.

Fungal infections 

In some cases, fungal infections cause endocarditis. Fungi, such as yeast, can live in parts of your body. Fungal infections generally happen in people who have weakened immune systems that cannot stop the fungus from growing. The weakened immune system can result from other diseases directly or from treatment of specific disorders, cancers and HIV-AIDS.

In general, endocarditis is rare. If you are healthy, your immune system usually destroys the germs in your bloodstream before they can cause harm. But your chance of developing endocarditis may be higher than most people if you:

• Have certain heart conditions: Damaged or abnormal heart tissue and devices in your heart can trap germs more easily than healthy heart tissue. That means your risk of endocarditis is higher if you have:
  • Heart valve disease
  • Prior heart valve replacement
  • A pacemaker or an implantable defibrillator
  • Certain congenital heart defects
• Have a condition or take medications that weaken your immune system
• Have a long-term central venous line, a tube that stays in a large vein for weeks or months for medical treatment.
• Inject illegal drugs: Unclean needles may carry bacteria into the bloodstream.
• Are older. Age-related changes to the heart valves, such as mitral valve prolapse or calcium deposits in the aortic valve, create places for germs to attach to the heart.
• Have already had endocarditis. Endocarditis can damage heart tissue, which increases your risk of getting it again.
• Don’t take care of your teeth and gums. Poor dental health makes it easier for germs to get into your bloodstream through your gums and mouth.

When the germs are in your heart, they can clump together with blood cells. These clumps can break off and travel through your bloodstream. They may block blood flow, spread infection or damage your organs, including your brain, lungs, kidneys and spleen. Endocarditis may sometimes lead to sepsis, a medical emergency that happens when your body has an extreme response to the infection. Endocarditis can also directly cause more serious heart problems including:

• Heart valve damage causing severe abnormal function
• Heart failure
• Arrhythmia: a problem with the rate or rhythm of your heartbeat

To find out if you have endocarditis, your healthcare provider will:

• Ask about your medical history, including your symptoms, recent illnesses and other health conditions that affect your chance of developing endocarditis.
• Do a physical exam to detect new or worsening heart murmur (an unusual sound heard with a stethoscope during or between heartbeats)
  • Skin lesions or joint swelling may provide important clues to the diagnosis
• Send you for lab testing, such as:
  • Blood tests to check for signs of infection, bacteria or fungi in your blood
  • Chest x-rays
  • Heart tests, especially echocardiogram, which uses sound waves to directly image the heart and its internal structures

If you have a higher chance of developing endocarditis than most people, you can reduce your risk if you: 

• Emphasize good dental care. Take good care of your teeth and gums every day.  
  • Regular cleanings can help reduce the number of bacteria that grows in your mouth.  
  • Have dental exams and cleaning at your dentist’s office every 6 months
• Make heart-healthy habits part of your daily life to help prevent heart disease
• Are treated with preventative antibiotics in high-risk settings. People with the highest risk for bacterial endocarditis need antibiotics before dental visits or certain medical or surgical procedures. Ask your provider if you're part of the highest risk group. If so, let all your providers know about your risk.