Endocarditis is inflammation of the inside lining of the heart chambers and heart valves (endocardium).
Endocarditis can involve the heart muscle, heart valves, or lining of the heart. Most people who develop endocarditis have a:
Endocarditis begins when different germs enter the bloodstream and then travel to the heart.
Germs are most likely to enter the bloodstream during:
Symptoms of endocarditis may develop slowly or suddenly.
Fever, chills, and sweating are the classic symptoms. These sometimes can:
Fatigue, weakness, and aches and pains in the muscles or joints may also be present.
Other symptoms can include:
The health care provider may detect a new heart murmur, or a change in a past heart murmur.
An eye exam may show bleeding in the retina and a central area of clearing. This is known as Roth's spots. There may be small, pinpoint areas of bleeding on the surface of the eye or the eyelids.
Tests that may be done include:
You may need to be hospitalized at first to receive antibiotics through a vein (IV or intravenously). Blood cultures and tests will help your health care provider choose the best antibiotic.
You will then need long-term antibiotic therapy.
Surgery to replace the heart valve is usually needed when:
Getting treatment for endocarditis right away improves the chances of a good outcome.
More serious problems that may develop include:
Call your health care provider if you notice the following symptoms during or after treatment:
The American Heart Association recommends preventive antibiotics for people at risk for infectious endocarditis, such as those with:
These patients should receive antibiotics when they have:
Valve infection; Staphylococcus aureus - endocarditis; Enterococcus - endocarditis; Streptococcus viridans - endocarditis; Candida - endocarditis
Fowler VG Jr, Scheld WM, Bayer AS. Endocarditis and Intravascular Infections. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009; chapt 77.
Karchmer AW. Infective Endocarditis. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 67.
Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007 Oct 9;116(15):1736-54.
Updated by: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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