Endocarditis

Endocarditis is inflammation, with or without infection, that affects the inside lining of the heart and heart valves.

What Causes Endocarditis?

Bacteria or fungi are the usual cause. Bacteria include Staphylococcus and Streptococcus. The bacteria or fungi can get to the heart by entering the bloodstream from infections somewhere else in the body (e.g., urinary or gastrointestinal tract or skin). Surgical or dental procedures can also let these organisms reach the heart.

What Are the Symptoms of Endocarditis?

Symptoms include fever, fatigue, weakness, chills and night sweats, muscle and joint pain, and heart murmur. Later symptoms are swelling of feet and legs and shortness of breath with an irregular heartbeat.

How Is Endocarditis Diagnosed?

The health care provider can make a diagnosis by taking a medical history, doing a physical examination, and getting blood cultures and an echocardiogram (ultrasound of the heart). The health care provider usually finds a new heart murmur due to the damaged heart valve at the physical.

How Is Endocarditis Treated?

Intravenous antibiotics, usually given for 4 to 6 weeks, are used to get rid of the infection. A home health nurse will help with intravenous antibiotic treatment at home. Nonaspirin medications such as acetaminophen can be used for fever and minor pain. A regular diet can be followed. Fluid intake should be increased for fever. Good dental hygiene is needed to prevent infection.

Another goal is to treat complications (e.g., congestive heart failure or blood clots). The health care provider may suggest surgery in some cases. Surgery may be needed for congestive heart failure that doesn’t respond to usual therapy, endocarditis caused by fungi, recurrent blood clots, abscesses leading to heart rhythm abnormalities, and lasting high fever or sepsis after 72 hours of antibiotics.

DOs and DON’Ts in Managing Endocarditis:

• DO take your antibiotics until they’re gone. Endocarditis may be prevented by using antibiotics before dental procedures if you have a history of prior infectious endocarditis, heart transplant, certain congenital heart diseases, or prosthetic valves.
• DO use nonaspirin drugs for fever and minor pain.
• DO increase fluid intake, especially during fever.
• DO resume normal activity slowly as your strength allows.
• DO see your dentist regularly. Use a soft-bristled toothbrush.
• DO call your health care provider if, after your treatment, you have fever, loss of appetite or weight gain without diet changes, blood in your urine, chest pain, shortness of breath, or sudden weakness in muscles of your face or limbs.
• DON’T skip doses or stop taking antibiotics until you finish a complete treatment course, or until your health care provider tells you to stop.
• DON’T try to keep your normal schedule; you need rest for a full recovery.
• DON’T have dental work or surgical procedures without telling your health care provider of your history of endocarditis.