Endocarditis

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
Bacterial Endocarditis
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Risk Factors

Factors that may increase your risk of endocarditis include:

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:

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

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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.

RESOURCES

American Heart Association
http://www.heart.org

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

CANADIAN RESOURCES

Canadian Dental Association
http://www.cda-adc.ca

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

References

Braunwald E, Zipes DP, Libby P, et al. Heart Disease: A Textbook of Cardiovascular Medicine. 6th ed. Philadelphia, PA: WB Saunders Company; 2001.

Cecil RL, Goldman L, Bennett JC. Cecil Textbook of Medicine. 21st ed. Philadelphia, PA: WB Saunders Company; 2000.

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%5FUCM%5F307108%5FArticle.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 http://www.ebscohost.com/dynamed: Wilson W, Taubert KA, et al. Prevention of infective endocarditis. Guidelines from the American Heart Association.Circulation. 2007;116(15):1736-1754.

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