Heart Disease Information/Types of Heart Disease

Libman-Sacks Endocarditis: Diagnosis, Symptoms, and Treatment

Medically reviewed by Vedran Radonić, M.D., Ph.D.

Written by Jazmin N. McSwain, Pharm.D., BCPS

Updated on September 4, 2026

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Key Takeaways

Libman-Sacks endocarditis is a rare type of heart disease that can quietly damage heart valves without causing noticeable symptoms.

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Not every heart disease causes obvious symptoms. Libman-Sacks endocarditis (LSE) is a type of heart disease that can develop quietly, damaging the heart valves without noticeable symptoms.

LSE, also called verrucous endocarditis, is a type of nonbacterial thrombotic endocarditis that can cause abnormal growths on the heart valves. These growths are linked to inflammation. In this article, we’ll discuss what LSE is, how it’s diagnosed, and what treatments are available.

What Is Libman-Sacks Endocarditis?

Your heart continuously pumps blood throughout your body. Valves are strong flaps of tissue that act like doors, opening and closing to keep blood flowing in the right direction. The sounds made when your heart valves close are part of the heartbeat that you hear.

🗳️ Have you been diagnosed with Libman-Sacks endocarditis?

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LSE most often affects two valves in your heart:

Mitral valve — Helps blood flow from the upper chamber to the lower chamber on the left side of the heart
Aortic valve — Helps blood leave the heart and travel to the rest of the body

LSE causes vegetations (growths) on these valves. The growths are made mostly of fibrin (a protein involved in blood clotting), platelets (cell fragments that help blood clot), immune complexes, and immune cells. The vegetations are sterile, meaning they aren’t caused by an infection, unlike infective endocarditis.

When vegetations damage the heart valves, they can lead to conditions such as:

Aortic or mitral regurgitation — Blood leaks backward because a valve doesn’t close properly.
Mitral or aortic stenosis — A valve becomes narrow or stiff, which can reduce blood flow.

Regurgitation and stenosis can make it harder for the heart to pump blood efficiently. LSE can also lead to complications such as embolisms (blockages caused by material traveling through the bloodstream) and valvular dysfunction, which means the heart valves don’t work properly.

Heart valve tissue with orange-colored growths called vegetations, seen in Libman-Sacks endocarditis. — In Libman-Sacks endocarditis, abnormal growths called vegetations form on the valves of the heart, interfering with blood flow. The vegetations in this image are orange in color. (CC BY-SA 3.0/Sara Mohsin)

What Causes Libman-Sacks Endocarditis?

Most cases of endocarditis — inflammation of the lining of the heart, including the heart valves — are caused by infections, often bacterial. However, LSE isn’t caused by an infection. It’s often linked to autoimmune conditions, such as systemic lupus erythematosus (SLE, commonly called lupus) and antiphospholipid syndrome (APS), as well as various types of cancer.

LSE may first develop when inflammation damages the lining of the heart valves. In people whose blood is more likely to clot, fibrin and platelets may collect in these damaged areas and form small vegetations.

Some people with autoimmune diseases are more likely to develop LSE. In lupus, the immune system mistakenly attacks the body’s own tissues. This can cause inflammation throughout the body, including the heart.

Lupus can also affect the way your blood clots. In people with a higher tendency to form blood clots, platelets and fibrin can collect on damaged areas of the heart.

Some people with lupus have antiphospholipid antibodies. These antibodies can make the blood more likely to form clots and may be associated with antiphospholipid syndrome. APS is linked to valve abnormalities and nonbacterial vegetations.

Who Develops Libman-Sacks Endocarditis?

LSE is rare and may go undiagnosed because it often doesn’t cause any symptoms. Some studies estimate that it affects 0.9 percent to 1.6 percent of people, although it may be missed during a person’s lifetime.

LSE can occur at any age, but it’s most often found in adults between ages 40 and 80. Nonbacterial thrombotic endocarditis is most commonly linked to people who have certain conditions, such as:

Cancer
Systemic lupus erythematosus
Antiphospholipid syndrome
Rheumatoid arthritis

For people with lupus and LSE, there also may be a relationship between lupus disease activity and LSE. More active lupus may be associated with LSE and its effects on the heart valves.

Doctors and researchers have found that people with both lupus and antiphospholipid antibodies are more likely to have LSE than those with only one of these conditions.

Symptoms of Libman-Sacks Endocarditis

Many people with LSE have no symptoms. LSE is often found while doctors are checking for other heart problems. When symptoms do occur, they may be related to heart valve damage or complications of LSE.

In severe cases, people may develop complications that cause noticeable symptoms, such as:

Heart failure — A serious condition that can develop when valve damage affects how well the heart pumps blood. Symptoms may include shortness of breath, fatigue, and swelling in the feet and legs.
Secondary infective endocarditis — An infection of the inner lining of the heart or heart valves that can occur in addition to LSE. Symptoms may include chest pain, weight loss, fever, and fatigue.
Systemic thromboembolism — A blood clot or other material travels through the bloodstream and blocks blood flow somewhere in the body. Depending on where the blockage occurs, symptoms may include pain, numbness, or coldness in an arm or leg.
Cerebrovascular embolism — A blood clot or other material blocks blood flow to part of the brain and may cause a stroke. Symptoms can include trouble speaking, vision changes, confusion, or numbness or weakness in the face, arm, or leg.

People with lupus and antiphospholipid syndrome may also have symptoms related to those conditions. In some cases, it can be difficult to tell whether symptoms are caused by lupus, APS, or LSE.

How Is Libman-Sacks Endocarditis Diagnosed?

There’s no single test to diagnose LSE. Instead, doctors may perform a physical exam, blood tests including blood cultures, and imaging tests to look for signs of LSE and rule out other conditions. Blood cultures can help determine whether an infection, such as infective endocarditis, is causing the heart valve changes.

Physical Exam

During your physical exam, your doctor will listen to your heart to check for murmurs, or abnormal whooshing sounds caused by blood flowing through the heart. A murmur may be a sign that a heart valve isn’t working properly.

If your doctor hears a murmur or finds other signs of heart problems, they may refer you to a cardiologist (a doctor who specializes in heart conditions) for more testing.

Imaging Tests

Your cardiologist may use an echocardiogram to look for LSE vegetations, valve thickening, or other changes. An echocardiogram uses sound waves to create pictures of your heart and heart valves. Two types of echocardiographic studies may be used:

Transthoracic echocardiography (TTE) — A transducer (wand) is moved over your chest to create images of your heart and valves.
Transesophageal echocardiography (TEE) — A thin, flexible tube with a transducer is passed down your esophagus to get more detailed images of the heart. This test may be used if TTE doesn’t provide clear enough images or if LSE is still suspected after a TTE.

A review of the literature shows that TEE is more sensitive than TTE for detecting LSE vegetations and valve problems. For this reason, TEE may be recommended when LSE is strongly suspected.

Blood Work

If your doctor suspects that lupus or APS may be related to your LSE, they may order blood work to look for signs of these conditions. Identifying an underlying condition can help your doctor determine the appropriate treatment.

How Is Libman-Sacks Endocarditis Treated?

There isn’t a single treatment for LSE, and the best strategy isn’t well established. Your doctor will choose treatment based on your symptoms, complications, and any underlying disease. Your treatment may include:

Corticosteroids — These immunosuppressive medications reduce inflammation in the body and may be used to treat an underlying inflammatory condition. Limited evidence suggests they may also help slow the progression of LSE vegetations.
Anticoagulation (blood thinners) — Anticoagulants may be used to help prevent new blood clots, particularly in people who have had a thromboembolic event or have APS.
Surgery — In some LSE cases, surgery may be needed for severe heart valve problems or recurrent embolisms. Depending on the valve damage, surgery may involve repairing the valve or heart valve replacement.

If you have lupus or APS, it’s important to have regular follow-up appointments with your doctor. They can monitor your heart and underlying condition and watch for complications.

If you’re living with LSE, your doctors can work with you to manage the underlying condition and lower your risk of complications.