Definition

The endocardium is the inner lining of the heart muscle. Endocarditis is an infection of this lining and the heart valves.

Causes

Causes of endocarditis include:

• Bacterial infection —the most common cause
• Viral or fungal infection
• Medical conditions that result in blood clotting too easily, causing a noninfectious form

Risk Factors

Factors that may increase your risk of endocarditis include:

• Having an artificial heart valve
• History of endocarditis
• History of rheumatic fever, which can damage heart valves
• Heart defects
• Enlarged heart
• Mitral valve prolapse
• History of IV drug use
• Recent procedures that can lead to bacterial endocarditis, including:
  • Tooth cleaning
  • Tonsillectomy and adenoidectomy
  • Bronchoscopy
  • Surgery on the gastrointestinal, urinary, or respiratory tracts
  • Gallbladder or prostate surgery

Symptoms

Symptoms of endocarditis include:

• Fever, chills
• Weakness, low energy
• Sweatiness, especially at night
• Shortness of breath
• Cough
• Loss of appetite, weight loss
• Chest pain
• Abdominal pain
• Nausea and vomiting
• Painful red bumps on the fingers and toes
• Purple dots on the whites of the eyes, under the fingernails, and over the collarbone
• Painful red patches on the fingers, palms, and soles

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. The doctor will check your heart for unusual heart sounds. These are called heart murmurs.

Tests include:

• Blood tests
• Echocardiogram

Treatment

Treatment may include:

• Antibiotics—given by IV for up to 4-8 weeks
• Surgery—to repair or replace the valve if it is severely damaged or has caused heart failure

Prevention

If you have a high risk of infection:

• You may need to take antibiotics before certain dental or medical procedures.
• Talk to your dentist or doctor before the procedure.

The American Heart Association guidelines recommend that preventive antibiotic therapy should be considered for individuals with the following cardiac conditions:

• Various forms of congenital heart defects
• Artificial heart valves
• History of endocarditis
• Heart transplant recipients who have developed valve disease

Avoiding illicit IV drugs will also decrease your risk of infection.

Mouth Healthy—American Dental Association http://www.mouthhealthy.org

Heart and Stroke Foundation of Canada http://www.heartandstroke.com

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Conn HF, Rakel RE, et al. Conn’s Current Therapy 2001: latest approved methods of treatment for the practicing physician. 53rd ed. Philadelphia, PA: WB Saunders Company; 2001.

Infective endocarditis. American Heart Association website. Available at:
http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/TheImpactofCongenitalHeartDefects/Infective-Endocarditis_UCM_307108_Article.jsp
Updated March 20, 2013. Accessed March 20, 2013.

Infective endocarditis. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
Updated September 5, 2012. Accessed March 20, 2013.

DynaMed’s Systematic Literature Surveillance
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