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The heart

What is endocarditis?

Endocarditis is an infection of the heart's valves or its inner lining (endocardium). It is most common in people who have a damaged, diseased, or artificial heart valve.

Endocarditis is caused by bacteria (or, in rare cases, by fungi) that enter the bloodstream and settle on the inside of the heart, usually on the heart valves. Bacteria can invade your bloodstream in many ways, including during some dental, surgical, and medical procedures. If you don't take care of your teeth, having your teeth cleaned or even brushing your teeth can cause bacteria to enter the bloodstream.

See a picture of endocarditisClick here to see an illustration..

What increases the risk for endocarditis?

If you have a normal heart, you have a low risk for endocarditis. But if you have a problem with your heart that affects normal blood flow through the heartClick here to see an illustration., it is more likely that bacteria or fungi will attach to heart tissue. Some health care procedures or implanted devices may raise your risk for endocarditis. This is because they can let bacteria or fungi enter your bloodstream.

You have a higher risk of endocarditis if you have:

  • Had endocarditis in the past.
  • An implanted heart device such as a pacemakeror implantable cardioverter-defibrillator (ICD).
  • Hemodialysis or a central venous catheter.
  • Abnormal or damaged heart valves or an artificial heart valve.
  • A congenital heart defect.
  • Injected illegal drugs using dirty needles or without cleaning the skin.
  • HIV.

Not all heart problems give you a higher risk of endocarditis. You do not have a higher risk if you have:

  • Coronary artery bypass graft surgery (bypass surgery).
  • Previous rheumatic fever without heart valve damage.
  • A heart attack without other complications.
  • Mitral valve prolapse without mitral valve regurgitation or unusually thickened valve leaflets.
  • A coronary artery stent.

What can you do if you are at risk for endocarditis?

If you have certain heart conditions, getting endocarditis is even more dangerous for you. These heart conditions include:

  • Artificial heart valves.
  • Endocarditis in the past.
  • Heart defects since birth (congenital heart defects).
  • Heart valve problems after a heart transplant.

If you have any of these heart conditions, you may need to take antibiotics before you have certain dental and surgical procedures. The antibiotics lower your risk of getting endocarditis. If you do not have these conditions, antibiotics are not likely to help you.

Procedures that may require antibiotics include:

  • Certain dental work or dental surgery.
  • Lung surgery.
  • Surgery on infected skin, bone, or muscle tissue.
  • Certain medical procedures, such as a biopsy.

Practicing good oral hygiene is especially important to prevent endocarditis if you are at risk.

Your doctor can give you a card to carry in your wallet. The card states that you may need preventive antibiotics before certain procedures.

What are the symptoms?

The symptoms of endocarditis progress as the bacteria or fungi grow in your heart. Vague, flu-like symptoms, such as a low-grade fever and fatigue, often occur first. Most people with endocarditis begin to have symptoms within 2 weeks after becoming infected with bacteria or fungi.

But a powerful strain of bacteria may cause symptoms to appear much faster, within a few days.

Symptoms include:

  • Chills and fever.
  • Fatigue.
  • Weight loss.
  • Night sweats.
  • Painful joints.
  • Persistent cough and shortness of breath.
  • Bleeding under the fingernails.
  • Tiny purple and red spots under the skin.

Although symptoms are vague and may not seem worth telling your doctor about, if they don't go away or if you know you are at risk for endocarditis, contact your doctor.

If endocarditis is not treated, the bacteria that cause endocarditis can form growths on or around the heart valves. The growths prevent the heart valves from opening and closing properly. This interrupts the normal blood flow through the valves and interferes with the heart's pumping action. Blood can leak backwards instead of being pumped forward. Over time, heart failure can develop, because your heart may not be able to pump enough blood to meet your body's needs.

Endocarditis can also cause other problems, including:

  • Abnormal heartbeat.
  • Stroke.
  • Kidney failure.

How is endocarditis diagnosed?

First your doctor will ask about your medical history and do a physical exam. If your doctor thinks that you may have endocarditis, he or she will check for signs of the infection, such as a heart murmur, an enlarged spleen, skin rashes, and bleeding under your nails.

Blood cultures will be done to check for bacteria in your bloodstream. And other tests, such as an echocardiogram, may be done to check your heart function and look at your heart valves.

It is important to treat endocarditis as soon as possible to avoid permanent damage to the heart muscle or heart valves.

How is it treated?

Antibiotics given through a vein (intravenously, or by IV) are the usual treatment for endocarditis. If your heart valves are damaged by the infection or if you have an artificial heart valve, surgery to repair or replace the valve may be needed. You may also need surgery if your endocarditis is caused by a fungus. If it is not treated, endocarditis can be fatal.

Frequently Asked Questions

Learning about endocarditis:

  • What is endocarditis?
  • What are the symptoms of endocarditis?

Being diagnosed:

  • How is endocarditis diagnosed?

Getting treatment:

  • What treatment will I need for endocarditis?
  • What is a central venous catheter?

Ongoing concerns:

  • Who needs antibiotics to prevent endocarditis?
  • What medical procedures may require antibiotics to prevent endocarditis?

Living with endocarditis:

  • What kind of home treatment will I need?

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