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Endocarditis: Symptoms, Testing, and Treatment

Medically reviewed by Steven Kang, M.D.
Written by Maureen McNulty
Posted on February 28, 2023

Endocarditis is a very serious heart condition. It occurs when the inner lining of the heart or the heart valves become inflamed.

In most cases, endocarditis is caused by an infection. When germs grow within the heart, they can damage the heart tissue, leading to holes in the valves.

Endocarditis is rare. Each year, about 3 to 7 people in 100,000 develop the condition. However, it has become more common in recent years as more older adults undergo surgeries, which can increase the risk of an infection leading to endocarditis.

Endocarditis Signs and Symptoms

Endocarditis usually causes a fever in addition to other symptoms. Some people will experience only mild symptoms, while others will have more severe health changes. Sometimes, people mistake endocarditis for another condition that causes similar symptoms, such as the flu.

Endocarditis can cause many types of symptoms, from head to toe. Call your doctor if you’re at risk of endocarditis and experience these symptoms, some of which can be mistaken for other illnesses.

Symptoms of endocarditis may include:

  • Fever, chills, or night sweats
  • Tiredness
  • Rash
  • Sore throat
  • Stuffy nose
  • Headaches
  • Soreness or tenderness near the cheekbones
  • Persistent cough
  • Chest pain when breathing
  • Shortness of breath
  • Muscle aches, pains, or weakness
  • Wounds or sores that are red or discolored, drain pus, or don’t heal
  • White areas inside of the mouth
  • Nausea, vomiting, diarrhea, or abdominal bloating
  • Unexpected weight loss

In some cases, endocarditis can also cause pain on the upper left side of the abdomen or blood in the urine. Brown, purple, or red nodules or spots — especially on the palms, fingers, soles of the feet, or toes (called Osler nodes and Janeway lesions) — may also be a symptom of the condition.

If you’re at high risk of endocarditis and experience symptoms, contact your doctor immediately. Without treatment, endocarditis may lead to an irregular heartbeat, heart failure, stroke, sepsis (a serious reaction in which multiple organs become damaged or shut down), or even death.

Causes and Risk Factors of Endocarditis

When germs like bacteria or fungi enter your blood, they can travel to your heart and start growing there. Endocarditis caused by a bacterial infection is also known as bacterial endocarditis or infective endocarditis.

Typically, the germs that cause endocarditis come from the bacteria that naturally grow on your skin, in your mouth or digestive system, or inside your airways. The bacteria can move into your bloodstream when you eat, floss or brush your teeth, have a bowel movement, undergo surgery, or develop a skin condition or burn.

When germs grow within the heart, they can damage the tissue and cause holes in the valves, leading to endocarditis.

You are more likely to experience endocarditis if you have:

  • Certain heart defects, including conditions that affect your heart valves
  • Artificial heart valves
  • A medical device such as a pacemaker
  • A condition that requires you to use an IV line or catheter
  • A history of using IV or injectable drugs
  • A need for surgery involving your airways, urinary tract, skin, bones, muscles, or mouth
  • Dental problems
  • A weakened immune system

If you’ve had endocarditis in the past, you’re more likely to get it again. Furthermore, the risk of endocarditis increases with age.

Diagnosis of Endocarditis

Your doctor may use several tests to diagnose potential heart problems. Blood tests can be used to look for certain bacteria and signs of inflammation, such as C-reactive protein. Blood tests can also measure your levels of white blood cells, which are often elevated when you have an infection.

You may also need to undergo an echocardiogram (echo), in which sound waves are used to produce a picture of your heart. You might have either a transthoracic echo (on your chest, overlying the heart) or a transesophageal echo (within the esophagus, just behind the heart). This test can help health care providers see signs of inflammation, such as abscesses (pockets of pus), growths, leaking, or other problems with your heart tissue. An electrocardiogram (ECG) can also help show if endocarditis or another condition is causing problems with the way the heart is beating.

Imaging tests such as a chest X-ray, an MRI, or a CT scan can also be useful in pinpointing which tissues are affected by an infection.

Endocarditis Treatments

Because endocarditis is usually caused by a bacterial infection, antibiotic therapy is often a part of treatment. These medications are given at high doses through an IV. You may need many antibiotic treatments over the course of several weeks. On the other hand, if endocarditis is caused by a fungus, then antifungal medication is given.

If endocarditis has seriously damaged your heart’s structure or you have repeated episodes of endocarditis, surgery may be necessary. Surgical procedures can help heal or replace damaged heart valves that are no longer working properly. If you need a heart valve transplant, you may get artificial valves or valves from a pig, cow, or human.

As you undergo treatment, watch for indications that your endocarditis is worsening, such as fever, joint pain, headaches, or breathing difficulties. Tell your doctor if you notice any of these symptoms returning or getting worse.

Can Endocarditis Be Prevented?

If you have risk factors that could increase your chances of developing endocarditis, your doctor may recommend going on antibiotics to help prevent this condition. For example, you may need to take an antibiotic if you have a heart condition and need to undergo surgery or a dental procedure.

Practicing good oral health can also help reduce your risk. Brush your teeth twice a day, floss once daily, and visit your dentist regularly.

Talk With Others Who Understand

MyHeartDiseaseTeam is the social network for people living with heart disease and their loved ones. On MyHeartDiseaseTeam, more than 56,000 members come together to ask questions, give advice, and share their stories with others who understand life with heart disease.

Have you been diagnosed with endocarditis? What symptoms did you have? Share your experience in the comments below, or start a conversation by posting on your Activities page.

Posted on February 28, 2023
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Steven Kang, M.D. is the Director of Cardiac Electrophysiology at Alta Bates Summit Medical Center and Alameda Health Systems in Oakland, California. Learn more about him here.
Maureen McNulty studied molecular genetics and English at Ohio State University. Learn more about her here.

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