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Infective endocarditis


What is infective endocarditis? 

Infective endocarditis is an inflammation of the heart caused by a bacterial or fungal infection of the heart valves or the inner lining of the heart (endocardium). If it is not treated quickly, it can lead to life-threatening complications.

Who is at risk?

Endocarditis is very rare in people who don’t already have a heart condition. There are four main groups of people who are at risk for infective endocarditis.

  1. People with underlying heart problems such as congenital heart disease, valvular heart disease, hypertrophic cardiomyopathy, rheumatic heart disease, or previous bouts of endocarditis.
  2. People who have undergone heart valve repair or replacement, or have had a pacemaker inserted into their chest.
  3. Intravenous drug users.
  4. People who are immunocompromised by such things as an organ transplant or HIV.

If you are in one of these groups, any situation or procedure that could allow bacteria to enter your bloodstream puts you at risk for infection. That can include anything from having your teeth cleaned, getting a tattoo or piercing, to complex surgery. Maintaining good oral hygiene (brushing, flossing, and having regular dental check-ups) can help to prevent infection. So can avoiding tattooing or piercing. Ask your doctor about taking antibiotics before undergoing any procedure in order to reduce your risk.

Preparing for dental work
If you are in one of the groups that are at risk of developing infective endocarditis, you need to prepare for dental work.

  • Ask your doctor if any you need to take any special precautions. You may be given a prescription for antibiotics.
  • Discuss your condition with your dentist before treatment starts.
  • Know the names of any medications you are taking.
  • Be prepared to give the dentist your doctor's name and address.
  • Be prepared to give permission for your dentist to consult your doctor.

The Canadian Dental Association has a Position Statement on Prevention of Infective Endocarditis. It provides a list of heart conditions in which antibiotics are recommended before certain dental procedures. 

Causes

Infective endocarditis occurs when bacteria or fungi enter the bloodstream and reach the heart. There are many ways that can happen:

  • by mouth
  • through open wounds
  • needles used in tattoos or piercing
  • illicit drug use
  • some dental procedures
  • catheters
  • infected cuts

Usually, when bacteria or other microorganisms enter the bloodstream, they are killed before they can do serious damage. When the heart is already damaged because of disease (for example congenital heart disease or valve disease) or surgery (such as implantation of an artificial heart valve or a pacemaker), the tissue becomes rough and bacteria can attach more easily to heart valves or the heart lining. This can have serious consequences.

 Symptoms 

The symptoms of endocarditis can develop over days or weeks depending on a person’s health and other disease factors.  
 
Common symptoms are:

  • fever
  • chills
  • weakness
  • fatigue
  • aching joints and muscles
  • night sweats
  • shortness of breath
  • paleness
  • persistent cough
  • swelling in the feet, legs or abdomen

Less common symptoms include:

  • unexplained weight loss
  • blood in your urine
  • a new heart murmur
  • tenderness in the spleen 
  • bleeding under the nails
  • flat, painless spots on the palms of your hands and soles of feet (Janeway lesions)
  • Painful, red bumps on the pads of the fingers and toes (Osler’s nodes)
  • Small red spots on the skin, whites of the eyes or mouth (petechiae)
Diagnosis 

Your doctor will diagnose endocarditis by doing a physical exam and assessing your:

  • signs and symptoms
  • medical history
  • test results

Some of the tests used to diagnose endocarditis are:

Treatment

Medication

Endocarditis is treated with long-term courses of intravenous antibiotics or antifungals. Each course can last as long as six weeks.
 
If you are taking medication, check with your doctor and dentist before you have dental work.
 
Here are some tips for managing your medications.
 
Surgery

In some cases, surgery to remove infected or damaged heart tissue is needed.
 
In severe cases of endocarditis, you might need to have a heart valve replacement if your heart is not pumping effectively or if the infection is not responding to the antibiotics.

Lifestyle

You can lower your risk of developing other heart diseases and stroke by knowing and controlling your blood pressure, diabetes and blood cholesterol. It’s also important to lead a healthy lifestyle.  

Talk to your doctor about the lifestyle changes that will benefit you the most.

 Complications 

When bacteria and cell debris accumulate inside the heart, clumps can break loose, form blood clots and travel through the bloodstream to other organs. Blood clots can cause serious complications throughout the body:

 
Recovery

It’s normal to feel worried or afraid after a diagnosis of infective endocarditis. Find someone you can turn to for emotional support like a family member, friend, doctor, mental health worker or support group. Talking about your emotions and feelings could be an important part of your journey to recovery. 

Related information

To find useful services to help you on your journey with heart disease, see our services and resources listing.

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