Endocarditis: Understanding Heart Valve Infection

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Endocarditis is a serious illness where the inside lining of the heart gets inflamed. This lining is called the endocardium. It happens mostly because of a bacterial infection, but fungi or other germs can also cause it. There are two main types: acute endocarditis starts fast with severe symptoms, while subacute (or chronic) develops slowly with milder symptoms.

In this blog, we’ll discuss these topics: 

What is  Endocarditis

Endocarditis is when the inside lining of your heart and heart valves gets infected. This lining is called the endocardium. The infection usually happens because bacteria, fungi, or other germs get into your bloodstream and travel to your heart. These germs stick to parts of your heart that are already damaged. Endocarditis can be serious and might harm your heart and other parts of your body if it isn’t treated quickly.

Causes of Endocarditis

Causes of Endocarditis

Endocarditis is an infection of the inner lining of the heart chambers and valves, known as the endocardium. This condition can be life-threatening if not treated promptly. The primary causes of endocarditis include:

1. Bacterial Infections

  • Staphylococcus aureus: This bacterium is a common cause of acute bacterial endocarditis and can enter the bloodstream through skin infections, wounds, or intravenous drug use.
  • Streptococci: Streptococcus viridans, found in the mouth, can cause subacute bacterial endocarditis, particularly after dental procedures.
  • Enterococci: These bacteria, often originating from the gastrointestinal or urinary tract, can cause endocarditis, especially in individuals with pre-existing heart conditions.
  • Other Bacteria: Other less common bacterial causes include Coxiella burnetii (Q fever), Bartonella species, and Brucella species.

2. Fungal Infections

  • Candida Species: These fungi can cause endocarditis, especially in individuals with weakened immune systems, those who have undergone prolonged antibiotic therapy, or those with intravenous catheters.
  • Aspergillus Species: Another fungal cause, more common in immunocompromised patients.

3. Intravenous Drug Use

  • Using non-sterile needles can introduce bacteria directly into the bloodstream, increasing the risk of endocarditis. Staphylococcus aureus is the most common pathogen associated with intravenous drug use.

4. Prosthetic Heart Valves

  • Individuals with artificial heart valves are at a higher risk of developing endocarditis because bacteria can adhere more easily to these foreign materials.

5. Previous History of Endocarditis

  • A history of endocarditis increases the risk of recurrence due to potential remaining pockets of infection or scarred heart tissue that can attract bacteria.

6. Congenital Heart Defects

  • Structural heart defects present from birth can create abnormal blood flow patterns, increasing the risk of bacterial infection in the heart.

7. Rheumatic Heart Disease

  • Damage to heart valves caused by rheumatic fever, a complication of untreated streptococcal throat infection, can predispose individuals to endocarditis.

8. Medical Procedures

  • Certain medical or dental procedures that involve the manipulation of infected tissues or the use of invasive devices can introduce bacteria into the bloodstream. Examples include dental surgeries, colonoscopies, or cystoscopies.

Symptoms of Endocarditis

While discussing causes, it’s also crucial to be aware of symptoms, as early detection and treatment are vital. Symptoms can include

  • Fever and chills
  • Heart murmurs
  • Fatigue
  • Muscle and joint pain
  • Shortness of breath
  • Persistent cough
  • Swelling in the legs, feet, or abdomen
  • Petechiae (tiny red or purple spots on the skin)
Diagnosing Endocarditis

Diagnosing Endocarditis

Diagnosing endocarditis involves a combination of clinical evaluation, imaging studies, and laboratory tests. Here’s a comprehensive overview of the diagnostic process:

1. Clinical Evaluation

  • Medical History: The doctor will take a detailed medical history to identify symptoms, risk factors, and any history of heart disease, intravenous drug use, recent dental or surgical procedures, or previous episodes of endocarditis.
  • Physical Examination: A thorough physical examination will be conducted, including listening to the heart for murmurs (abnormal heart sounds), checking for signs of infection, and looking for peripheral manifestations of endocarditis, such as petechiae, Janeway lesions, Osler nodes, and splinter hemorrhages.

2. Blood Tests

  • Blood Cultures: Multiple blood samples are taken at different times to detect the presence of bacteria or fungi in the bloodstream. Positive blood cultures are a key indicator of endocarditis.
  • Complete Blood Count (CBC): This test can reveal signs of infection, such as an elevated white blood cell count.

3. Echocardiography

  • Transthoracic Echocardiogram (TTE): This non-invasive ultrasound test uses sound waves to create images of the heart and can help detect vegetation (clumps of bacteria and cells) on the heart valves.
  • Transesophageal Echocardiogram (TEE): A more detailed imaging test where the ultrasound probe is inserted into the esophagus. TEE provides clearer images of the heart valves and is more sensitive in detecting small vegetations, abscesses, or other complications.

4. Electrocardiogram (ECG)

  • An ECG records the electrical activity of the heart. While not specific for diagnosing endocarditis, it can identify complications such as heart block or arrhythmias associated with the condition.

5. Chest X-ray

  • This imaging test can help identify complications such as heart enlargement or pulmonary congestion (fluid in the lungs), which can occur with endocarditis.

6. Computed Tomography (CT) Scan

  • A CT scan, particularly of the chest, abdomen, or pelvis, can help detect complications like emboli (clots that travel from the heart to other parts of the body) or abscesses.

7. Magnetic Resonance Imaging (MRI)

  • MRI can be useful in detecting embolic events in the brain or other organs that might suggest the presence.

Treatment Options for Endocarditis

Treatment for endocarditis aims to eradicate the infection, manage any complications, and prevent recurrence. The approach typically involves antibiotics, sometimes combined with surgical interventions. Here’s a detailed overview of the treatment options:

1. Surgical Intervention

Surgery may be necessary in the following situations:

  • Heart Failure: Severe valve dysfunction causing heart failure may require valve repair or replacement.
  • Uncontrolled Infection: Persistent infection despite appropriate antibiotic therapy, especially if there are abscesses or fistulas.
  • Prevention of Embolism: Large vegetations, particularly on the mitral valve, pose a high risk of embolism (clots traveling to other parts of the body).
  • Prosthetic Valve Endocarditis: Often requires removal and replacement of the infected prosthetic valve.

2. Management of Complications

  • Heart Failure Management: Diuretics, inotropes, and other heart failure medications may be used to manage symptoms until surgical intervention can be performed.
  • Embolic Events: Stroke or other embolic events require supportive care and may necessitate surgical intervention to remove the emboli.
  • Renal Failure: May require dialysis in severe cases.

3. Supportive Care

  • Hospitalization: Most patients require hospitalization, at least initially, for intravenous antibiotics and close monitoring.
  • Nutritional Support: Ensuring adequate nutrition is crucial, especially in prolonged illness.
  • Pain Management: Appropriate analgesics may be required to manage pain associated with the infection or its complications.

4. Preventive Measures

  • Prophylactic Antibiotics: Patients with certain high-risk conditions (e.g., prosthetic heart valves, previous endocarditis) may need antibiotics before dental or surgical procedures to prevent recurrence.
  • Lifestyle Modifications: Good oral hygiene, avoiding intravenous drug use, and regular medical follow-ups for heart conditions are important preventive strategies.

5. Follow-up and Monitoring

  • Regular Echocardiograms: To monitor heart function and check for the resolution of vegetations or other abnormalities.
  • Blood Tests: Repeated blood cultures to ensure the infection has been eradicated.
  • Clinical Evaluations: Regular follow-ups with a cardiologist or infectious disease specialist to monitor for any signs of recurrence or complications.

Best care for Endocarditis starts with the right doctor. Find them here:

Preventing Endocarditis

Preventing Endocarditis

Preventing endocarditis involves several strategies aimed at reducing the risk of infection, particularly for individuals who are at higher risk due to pre-existing heart conditions or other factors. Here are the key preventive measures:

1. Good Oral Hygiene

  • Regular Dental Care: Regular dental check-ups and cleanings are crucial. Good oral hygiene practices, such as brushing teeth at least twice a day and flossing daily, help prevent gum disease and other dental infections that can lead to endocarditis.
  • Prompt Treatment of Oral Infections: Any signs of dental or gum infections should be addressed promptly to prevent bacteria from entering the bloodstream.

2. Antibiotic Prophylaxis

  • High-Risk Patients: Certain patients are recommended to take antibiotics before specific dental or surgical procedures that may introduce bacteria into the bloodstream. These high-risk groups include:
    • Individuals with prosthetic heart valves.
    • Patients with a history of endocarditis.
    • Those with certain congenital heart defects.
    • Heart transplant recipients who develop valvulopathy.
  • Guidelines: Follow the guidelines provided by health organizations such as the American Heart Association (AHA) for antibiotic prophylaxis recommendations.

3. Avoiding Intravenous Drug Use

  • Substance Abuse Treatment: Seek help for substance abuse to reduce the risk of endocarditis from using non-sterile needles. Using clean, sterile needles and practicing safe injection techniques can help mitigate the risk if cessation is not immediately possible.

4. Managing Existing Health Conditions

  • Heart Conditions: Regular monitoring and management of pre-existing heart conditions can help reduce the risk of endocarditis. This includes managing conditions like rheumatic heart disease and congenital heart defects.
  • Chronic Illnesses: Proper management of chronic illnesses such as diabetes or autoimmune disorders can strengthen the immune system and lower the risk of infections.

5. Vaccinations

  • Preventative Vaccines: Staying up-to-date with vaccinations, such as the flu shot and pneumococcal vaccine, can help prevent illnesses that might lead to secondary infections, thereby reducing the risk of endocarditis.

6. Prompt Treatment of Infections

  • Early Intervention: Treat any infections promptly, particularly those that could spread to the bloodstream, such as urinary tract infections or skin infections.

7. Healthy Lifestyle Choices

  • Balanced Diet and Regular Exercise: Maintaining overall health through a balanced diet and regular exercise can strengthen the immune system.
  • Smoking Cessation: Avoiding smoking can improve cardiovascular health and reduce the risk of infections.


Q1. What Causes Endocarditis?

A1. Endocarditis is usually caused by an infection from bacteria, fungi, or other germs. These germs enter the bloodstream and travel to the heart, where they attach to damaged heart valves or tissue.

Q2. What is the Most Common Bacteria Causing Endocarditis?

A2. Most cases of endocarditis are caused by three types of bacteria: streptococci, staphylococci, and enterococci. Together, these bacteria cause 80-90% of all cases. Staphylococcus aureus is responsible for about 30% of cases in developed countries.

Q3. Is Endocarditis Curable?

A3. Endocarditis is an infection of the inner lining of the heart chambers and valves. While most people recover with treatment, it can be serious and damage the heart. Early diagnosis and treatment are very important.

Q4. What Antibiotics Are Used to Treat Endocarditis?

A4. To treat endocarditis, doctors often use a combination of antibiotics. These usually include vancomycin, gentamicin, and either cefepime or another antibiotic like imipenem, meropenem, or doripenem.

Q5. What is the Most Common Site of Infective Endocarditis?

A5. Endocarditis most often affects the left side of the heart. The mitral and aortic valves are the most common sites of infection, especially if there are existing problems like mitral valve prolapse or regurgitation (leakage).

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