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Endocarditis

Endocarditis is an infection caused by bacteria that enter the bloodstream and settle in the heart lining, a heart valve, or a blood vessel. It is uncommon, but people with some heart conditions have a greater risk of developing it.

There are two forms of endocarditis:

  1. Acute—develops suddenly and can be life-threatening within days.

  2. Subacute or chronic—develops slowly over a period of weeks to several months.

Because the heart valves are not supplied directly with blood, the body’s immune system, including the infection-fighting white blood cells, can't directly reach the valves. This means that if bacteria grows on the valves, it is hard to fight the infection, whether through the immune system or medications.

What happens once you have endocarditis?

Endocarditis may develop slowly or suddenly, depending on what germs are causing the infection and whether you have any underlying heart problems. Signs and symptoms of endocarditis can vary from person to person.

The acute version usually begins with fever, chills, fast heart rate, fatigue, night sweats, aching joints and muscles, persistent cough, or swelling in the feet and legs or abdomen.

The chronic version may include fatigue, mild fever, a moderately fast heart rate, weight loss, sweating, and a low red blood cell count (anemia).

Common signs and symptoms of endocarditis include:

  • Fatigue.

  • Night sweats.

  • Shortness of breath.

  • Aching joints and muscles.

  • Chest pain when you breathe.

  • Swelling in your feet, legs, or abdomen.

  • Flu-like symptoms, such as fever and chills.

  • A new or changed heart murmur is the heart sound made by blood rushing through your heart.

What causes endocarditis?

Endocarditis can come from many sources:

  • Burns.

  • Catheters.

  • Illegal IV drug use.

  • Dental procedures.

  • Poor dental hygiene.

  • Infectious diseases.

  • Chronic skin disorders and infections.

  • Implanted cardiovascular medical devices.

  • Tooth brushing that causes minor injury to the lining of the mouth or gums.


Risk factors for children and young adults include birth defects of the heart, such as malformed valves or a hole in the septum, which allow blood to leak from one part of the heart to another. Risk factors for adults include previous valve surgeries or a heart transplant, calcium deposits in the mitral valve or the aortic valve, congenital heart defects or a history of endocarditis.

What types of tests are used to diagnosis endocarditis?

Tests used to confirm or rule out endocarditis include:

  • Blood test: A blood test is used to identify any germs in your bloodstream or if you have a lot of white blood cells, which can be a sign of infection.

  • Echocardiogram: An echocardiogram shows how well your heart's chambers and valves are pumping blood.

  • Electrocardiogram (EKG ): An EKG can show if something is affecting your heart's electrical activity. Sensors that can detect your heart's electrical activity are attached to your chest, arms, and legs.

  • Chest X-ray: A chest X-ray can determine if endocarditis has caused heart swelling or if any infection has spread to your lungs.

  • Computerized tomography (CT) scan or magnetic resonance imaging (MRI): You may need a CT scan or an MRI scan of your brain, chest, or other parts of your body if your doctor thinks that infection has spread to these areas.

What types of treatments and procedures are used to treat endocarditis?

Many people with endocarditis are successfully treated with antibiotics. Sometimes, surgery may be needed to fix or replace damaged heart valves and clean up any infection signs.

Medications: High doses of IV antibiotics are used to treat endocarditis caused by bacteria. If you receive IV antibiotics, you'll generally spend a week or more in the hospital so your doctor can determine if the treatment is working. You'll usually take antibiotics for several weeks to clear up the infection.

If a fungal infection causes endocarditis, your doctor will prescribe antifungal medication. Some people need lifelong antifungal pills to prevent endocarditis from returning.

Surgery: Heart valve surgery may be needed to treat persistent endocarditis infections or replace a damaged valve. Surgery is also sometimes needed to treat endocarditis that's caused by a fungal infection.

What can I do to support my health when I have endocarditis?

If you're at high risk of endocarditis, the American Heart Association recommends taking antibiotics an hour before having any dental work done.

You're at high risk of endocarditis if you have:

  • A history of endocarditis.

  • A heart transplant, in some cases.

  • Certain types of congenital heart disease.

  • A man-made (prosthetic mechanical) heart valve.

  • Congenital heart disease surgery in the last six months.

If you have endocarditis or any congenital heart disease, talk to your doctor and dentist about your risks and whether you need preventive antibiotics.

Why choose Presbyterian for endocarditis treatment?

Presbyterian Heart and Vascular Care has a skilled interventional cardiology team who can provide a wide range of interventional and structural heart treatments. Their interventional cardiologists are trained in many different techniques and procedures, many of which can provide you with a shorter recovery period and the opportunity to recover at home.