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Understanding Endocarditis: Symptoms, causes, and treatment

Team AckoJun 23, 2024

The heart typically provides robust defences against infections, but vulnerabilities arise when heart valves sustain damage or are replaced with artificial ones. In such instances, bacteria find footholds, evading the body's immune defences. This breach in protection paves the way for endocarditis, a condition characterised by inflammation of the heart's inner lining. The consequences can be dangerous, as unchecked bacterial growth within the heart can lead to systemic complications such as septic emboli or abscess formation. 

Endocarditis poses a serious threat to overall cardiovascular health, requiring prompt diagnosis and treatment to prevent life-threatening complications. Understanding the mechanisms by which bacteria exploit weakened cardiac structures underscores the importance of preventive measures and vigilant management of heart health to safeguard against this potentially fatal condition. Read on to learn about Endocarditis, its symptoms, causes, and treatment





What is Endocarditis?

Endocarditis is caused by bacteria in blood circulation proliferating and spreading over your heart's inner lining (endocardium). Here, the endocardium becomes inflamed, causing heart valve damage. At the location of the infection, little clusters of bacteria might form. These aggregates have the potential to behave similarly to blood clots, obstructing blood flow to the organs. This can result in organ failure or a stroke.

What causes Endocarditis?

Bacteria that cause infective Endocarditis enter the circulation and infect the heart. Staphylococcus aureus (staph infection) and Streptococcus (strep) bacteria are commonly associated with infective Endocarditis.

Typically, heart valves are very resistant to bacterial adhesion and infection. As the germs migrate swiftly through the damaged valve lining, bacteria that can most strongly cling to the surface have the highest chance of causing infective Endocarditis. Clumps of bacteria and cells known as vegetation grow on the heart valves, interfering with the heart's function. If left untreated, this vegetation may leak the valve and cause an abscess close to the valve or in the valve itself.

What impact does Endocarditis have on my body?

Infective endocarditis, characterised by the formation of growths on heart valves, poses severe risks to the cardiovascular system. These vegetations can obstruct blood flow, increasing the likelihood of embolisms that may cause organ damage or stroke. Moreover, the toxins and enzymes produced by infecting microorganisms lead to tissue degradation, resulting in valve perforations and leakage, leading to valve dysfunction. 

This dysfunction manifests as heart block, irregular heart rhythms, or abscess formation around the valve. Left untreated, these complications can progress to heart failure, where the heart struggles to pump blood effectively, and sepsis, a life-threatening systemic infection. Prompt medical intervention is crucial to mitigate the potentially fatal consequences of endocarditis and preserve cardiovascular function.

Who is affected by Endocarditis?

Endocarditis, a serious infection of the inner lining of the heart chambers and valves, disproportionately affects certain demographics and individuals with specific medical conditions. Statistics reveal a higher incidence among individuals assigned male at birth, suggesting potential biological or behavioural factors influencing susceptibility. Moreover, the prevalence of endocarditis rises with age, with over a quarter of cases occurring in individuals aged 60 and older.

Several risk factors predispose individuals to bacterial endocarditis. Acquired valve diseases, such as rheumatic heart disease, and structural abnormalities like mitral valve prolapse or thickened valve leaflets increase vulnerability. Those with prosthetic heart valves, including bioprosthetic and homograft valves, face heightened risk, as do individuals with a history of bacterial endocarditis or congenital heart defects. Additionally, the presence of cardiac devices like pacemakers, compromised immune systems, and intravenous drug abuse habits elevate susceptibility.

Hypertrophic Cardiomyopathy 

Moreover, conditions like hypertrophic cardiomyopathy contribute to the risk profile. Understanding these risk factors enables healthcare professionals to identify high-risk individuals, implement preventive measures, and provide targeted interventions. By addressing predisposing factors and promoting awareness, efforts can be made to mitigate the burden of endocarditis and improve patient outcomes.

What are the common symptoms of Endocarditis?

The presenting symptoms are a persistent low-grade fever with no evident cause, exhaustion, and shortness of breath with exercise. Patients may also have joint and muscle discomfort, and their doctor may detect a new or altered murmur. Moreover, the following signs and symptoms can also appear:

  • A previously undetected heart murmur or a changing heart murmur

  • A fever of 100 to 103 degrees 

  • Chills and flu-like symptoms

  • Resting shortness of breath

  • Sweating at night

  • Pain in the chest during breathing

  • Foot, leg, or abdomen swelling

  • A fast heartbeat (tachycardia)

  • Weight loss due to appetite loss

  • Urine containing blood or blood cells (hematuria)

  • Tiny red dots on the eye conjunctiva and fingernails (splinter haemorrhages)

  • Small, painless patches on the palms or soles of the feet (Janeway lesions)

  • Nodules of pain in the fingers (Osler nodes)

Are there any associated complications?

Left untreated, Endocarditis can be life-threatening. Here are some complications. 

  • Infection of the heart valve causes tissue deterioration, valve leakage, and heart failure. 

  • An abscess with a rupture between distinct heart chambers may develop from infection spreading into the tissue around the valve. 

  • Clots (emboli) caused by infective Endocarditis can cause significant injury. Clots lodge in the brain in 20-40% of people with infective Endocarditis, causing weakness on one side of the body, loss of vision, or stroke. The location of the clot determines the symptoms. 

  • Clots can also induce stomach discomfort, flank pain, or extremities arterial insufficiency.

Are there any risk factors associated with Endocarditis?

Previous heart injury, recent heart surgery, or poor oral hygiene are the most frequent risk factors for infective Endocarditis. Various factors can make your heart more susceptible to infection and raise your risk of getting Endocarditis. Some conditions are:

  • Heart valve disease: It refers to health issues that affect the heart's valves. Heart valve disease can be congenital (you are born with the problem) or acquired (you develop the condition later in life and have artificial valves).

  • Aortic valve replacement surgery: It uses prosthetic (artificial) valves to replace heart valves destroyed by heart valve disease. Bacteria can grow around prosthetic valves, causing Endocarditis in some cases.

  • Drug-induced hypertrophic cardiomyopathy: The heart muscle cells grow, and the walls of the heart chambers thicken in hypertrophic cardiomyopathy. Because the chambers are smaller, they can't retain as much blood, and the walls can't relax correctly and may harden.

  • Congenital heart disease: Congenital heart illness is one of the most prevalent forms of congenital disabilities, with the most common being ventricular septal defect (VSD).

  • A previous history of Endocarditis studies reveals that individuals who once had Endocarditis are more likely to have it a second time.

  • Intravenous drug use with a contaminated needle.

Can Endocarditis be prevented?

The mouth is a crucial entry point for germs into the body, particularly Streptococcal species.

The American Heart Association suggests Penicillin prophylaxis for individuals with congenital heart disease and rheumatic heart disease before dental procedures like root canal therapy and extraction to reduce the chance of developing Endocarditis.

How is Endocarditis diagnosed?

Your doctor could recommend certain tests if you exhibit Endocarditis symptoms. A doctor will listen to your heart to check for any new or altered heart murmurs. Before rendering a diagnosis, they may request one or more of the following tests if they require further information:

  1. Blood test: These will check for germs in your circulation or reveal other Endocarditis-related conditions, such as anaemia, which denotes a lack of red blood cells.

  2. Electrocardiogram or echocardiography: These examinations demonstrate how your heart is functioning.

  3. X-ray: This will reveal if your heart or lungs have been impacted by Endocarditis.

  4. CT or MRI scan: These examinations utilise images to show your doctor whether the illness has moved to different parts of your body, such as your chest or brain.

How to treat Endocarditis

Early diagnosis and aggressive therapy are critical for the successful management of Endocarditis.

  • Antibiotics: A course of antibiotics can be used to treat Endocarditis patients. Before prescribing antibiotics, your doctor will often get a blood sample to ensure you receive the best antibiotics possible. If you are taking antibiotics at home, you should schedule routine visits with your doctor. Antibiotics often need to be taken for two to six weeks.

  • Your heart may suffer significant harm as a result of Endocarditis. Surgery can be required to fix cardiac damage in case your symptoms or test results point to heart failure, a critical illness in which your heart is not effectively pumping blood throughout your body. If you also have a fever after taking antibiotics. A cardiologist, who specialises in conditions of heart and blood vessel conditions, may be recommended to examine your heart.

Outlook and Recovery for Endocarditis

Endocarditis, if untreated, poses a fatal threat, underlining the critical importance of timely intervention. However, with prompt antibiotic treatment, most individuals can achieve recovery. The outlook hinges on various factors, including age and the underlying cause of infection. Early intervention significantly enhances the prospects of complete recovery. In cases requiring surgery, the recovery process may be prolonged. Despite this, adherence to treatment regimens and post-operative care can facilitate optimal healing. Patient education regarding the importance of timely medical attention is paramount in mitigating the severity of endocarditis and improving long-term outcomes.

Frequently Asked Questions (FAQs)

Here are some FAQs on Endocarditis.


Is Endocarditis related to dental hygiene?

A key component of preventing Endocarditis is dental hygiene. Through circulation, germs from oral diseases can go to your heart and infect it. Be sure to routinely see the dentist, clean and floss your teeth, and take care of your gums.

What results in Endocarditis in humans?

Bacteria proliferating and spreading throughout the inside lining of your heart is what causes Endocarditis (endocardium). Your heart valves are harmed as a result of the endocardium being inflamed. In most cases, your heart is adequately protected against infection, allowing germs to pass through unharmed.

Can Endocarditis be totally recovered from?

The majority of patients with Endocarditis recover with vigorous therapy. If you suspect you may have Endocarditis, be aware of the signs and symptoms and reach out to your doctor.

What are the common symptoms of Endocarditis?

The common symptoms of Endocarditis include persistent low-grade fever, exhaustion, shortness of breath with exercise, joint and muscle discomfort, new or altered heart murmurs, chills, flu-like symptoms, chest pain, swelling in the extremities, rapid heartbeat, weight loss, blood in urine, and various skin manifestations such as red dots on the eyes and nails, painless patches on palms or soles, and nodules in the fingers.

How is Endocarditis diagnosed?

Endocarditis can be diagnosed through physical examination, blood tests to check for bacteria and other indicators of the disease, electrocardiogram or echocardiography to assess heart function, X-rays to check for impact on heart and lungs, and CT or MRI scans to detect spread to other parts of the body.

How is Endocarditis treated?

Treatment for Endocarditis involves aggressive antibiotic therapy, often requiring hospitalisation and intravenous administration of antibiotics for two to six weeks. In severe cases, surgery may be necessary to repair heart damage. Regular follow-up with a cardiologist is essential for monitoring and managing the condition.

Are there any associated complications with Endocarditis?

Left untreated, Endocarditis can lead to life-threatening complications such as tissue deterioration, valve leakage, heart failure, development of abscesses, and formation of clots that can cause strokes or other organ damage.

What are the risk factors associated with Endocarditis?

Risk factors for Endocarditis include previous heart injury, recent heart surgery, poor oral hygiene, heart valve disease, aortic valve replacement surgery, drug-induced hypertrophic cardiomyopathy, congenital heart disease, a history of Endocarditis, and intravenous drug use with contaminated needles.


Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. Please consult a doctor before making any health-related decisions.


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