Infective Endocarditis

Treating Cardiovascular Diseases in Wisconsin and Northern Illinois

Infective endocarditisis an infection of the inner lining of your heart chambers and valves. It occurs when certain germs enter your bloodstream and get carried to the inside of your heart, or endocardium.

The body’s immune system often fights off these germs and no infection occurs. When this natural defense fails, the ensuing infection can cause a range of infective endocarditis symptoms (anchor link to symptoms section), often beginning withflu-like symptoms.

Over time, infective endocarditis can lead to serious complications, including growths or holes on the heart valves or scarring on the valve tissue. It can also affect the nervous system and other organs. Left untreated, it can be fatal.

About 29,000 adults and children in the United States are diagnosed with infective endocarditis each year, according to the American Heart Association.

Infective Endocarditis Symptoms 

Symptoms of infective endocarditiscan develop slowly or rapidly, depending on the type of germs that have invaded the bloodstream. These germs—bacteria, fungi and other microbes—are normally found in the mouth, on the skin, in the intestines and in the respiratory and urinary systems.

Common signs and symptoms of infective endocarditis include:

  • A new heart murmur or a change in an existing heart murmur
  • A wound that won’t heal
  • Blood in the urine
  • Flu-like symptoms, such as unusual fatigue, fever, chills, aching muscles and joints, night sweats, and headaches or tenderness in the upper cheekbones
  • Nausea, vomiting or diarrhea
  • Persistent cough
  • Shortness of breath
  • Sinus drainage and nasal congestion
  • Skin changes, including overall paleness or small painful bumps or spots from broken blood vessels
  • Sore throat or pain when swallowing; white patches in your mouth or on your tongue
  • Swelling in the feet, legs or abdomen

As the germs multiply in your heart, they form clumps, called vegetations. Sometimes pieces of the vegetation, known as emboli, break off and travel to other organs and body tissues, where they can cause any of the following complications:

  • Central nervous system disorders, which affect 20 to 40 percent of those with endocarditis, occur when emboli beak away and lodge in the brain, causing local infections, known as brain abscesses, or a more widespread brain infection, known as meningitis.
  • Damage to the kidneys and spleen can occur when pockets of pus develop near these vital organs.
  • Emboli can also affect the brain’s blood supply or electrical signals, causing a stroke or seizure which can result in long-term brain damage or fatalities.
  • Heart problems, the most common complication, affect 33 to 50 percent of those with infective endocarditis and may include a heart murmur, heart failure, heart valve damage, an arrhythmia or heart attack.
  • Lung complications are likely to occur when endocarditis affects the right side of the heart, and an emboli or blood clot lodges in the lung, causing a sudden blockage in a lung artery, known as a pulmonary embolism(link tbd). Other complications can include pneumonia or a buildup of fluid or pus around the lungs.

Causes and Risk Factors for Infective Endocarditis

Although endocarditis sometimes affects people with normal hearts, itis more likely to develop in people who have abnormal, artificial or damaged portions of the endocardium. Some of these conditions result in a rough surface that allows organisms to reproduce. Conditions that increase your risk include:

  • Artificial heart valves
  • Congenital heart defects
  • Damaged heart valves from calcium deposits or rheumatic fever
  • Heart transplantation
  • Hypertrophic cardiomyopathy
  • Implanted medical devices in the heart, such as a pacemaker wire
  • Mitral valve prolapse

Some risk factors make it easier for bacteria to enter the bloodstream. These include:

  • Having a catheter or other medical device in your body for long periods
  • Having a history of infective endocarditis
  • Having other infections in the body that spread to your bloodstream and heart
  • Having poor dental hygiene or unhealthy teeth and gums
  • Using intravenous drugs

Diagnosing Infective Endocarditis

If you have risk factors for endocarditis and exhibit anysigns of infective endocarditis, call your doctor right away. Diagnosis is based on many factors, including your risk factors, medical history, signs and symptoms, and results from any of the following tests:

  • Electrocardiograph testing (EKG), to check whether endocarditis is affecting your heart’s electrical system
  • Lab testing, to check your blood for bacteria and white blood cell counts
  • Ultrasound testing, including transthoracic echocardiography (TTE) and transesophageal echo (TEE)

Treating Infective Endocarditis

Most cases of infective endocarditis are treated with intravenous antibiotics for several weeks. People are initially hospitalized to make sure the treatments are effective. Many people can continue their remaining IV antibiotic treatment at home, which is set-up and monitored by home-care specialists.

In some cases, surgery is necessary to repair or replace a damaged heart valve or to clean up fungi, which is more difficult to treat than bacteria.

In the past, some people who were at risk for infective endocarditis were advised to take antibiotics as a preventive measure before any dental, gastrointestinal or urinary tract procedure. More recently, the American Heart Association no longer recommends this treatment, believing there may be greater risks from preventive antibiotic treatment therapy than potential benefits.

Antibiotics are still recommended for high-risk patients who have the following conditions:

  • Artificial heart valves
  • Certain types of congenital heart disease
  • Heart transplantation with heart valve disease
  • Previous endocarditis

Ask your doctor if preventive therapy is right for you.

A Leader in Treating Endocarditis

Aurora Health Care uses a comprehensive approach to treating endocarditis. Our team of experts includes infectious disease specialists who tailor the antibiotic regimen to each patient’s needs. Our cardiologists use advanced imaging techniques to diagnose and lead treatment efforts. They work collaboratively with our cardiac surgery team to treat those individuals who have valve decompensation that requires surgical intervention.

People choose Aurora for our well-known expertise, easy access and personal care. Patients from all over the country choose to have heart surgery at Aurora St. Luke’s Medical Center, where we handle a high volume of complicated cardiac conditions.

Aurora doctors are conveniently located throughout eastern Wisconsin and northeastern Illinois. Find a doctor or heart specialist near you. To get a second opinion or if you need assistance finding a provider, please call 888-649-6892.