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What is Endocarditis?

By Sheri Cyprus
Updated Jan 22, 2024
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Endocarditis is an inflammation of the heart's valves or inner lining. The condition occurs when germs from the mouth, intestines or skin reach the bloodstream and infect regions of the heart. Fungi has also been recognized as a causative source of the heart infection. Although endocarditis is not common, it does pose serious health risks.

Complications include congestive heart failure, blood clots, rapid or irregular heartbeats called arrhythmias, stroke, and damage to the nervous system and brain. Early treatment of endocarditis can result in a positive prognosis, but if left untreated, the infection can cause death.

People with pre-existing heart conditions are the most susceptible to developing endocarditis. The infection rarely occurs in people with healthy hearts. Surgeries and dental procedures that cause a significant amount of bleeding pose the biggest risk of endocarditis. Injection drug use and a history of rheumatic fever are some other risk factors in the development of the infection.

Symptoms may be subacute, meaning slow to develop, or acute, meaning to develop suddenly, and may include fever, chills, excessive sweating, hemorrhaging under the nails, and blood in the urine. Other signs of endocarditis include fatigue, weight loss, red spots on skin, and abdominal swelling or swelling of feet and legs.

Medical examinations may reveal an enlarged spleen, new heart murmur or changes in an existing heart murmur, splinter hemorrhages beneath the nails, or clubbing (curving) of the fingernails. Repeated blood culture testing is often considered the most reliable method of detecting endocarditis. Eye examinations are also commonly done when endocarditis is suspected as the eye membrane called the conjunctiva may contain retinal hemorrhages known as Roth's spots, and/or small hemorrhages called petechiae.

Serology, which is a blood test used to detect antibodies produced against a microorganism, may be conducted if blood culture fails to detect bacteria. Viral endocarditis is a subtype of endocarditis, but microorganisms such as bacteria and fungi, rather than a virus, are usually present in most cases of endocarditis.

Once bacteria is detected, antibiotics selected to eliminate the specific organism may be administered to the patient for up to 6 weeks. Antibiotics are usually started through intravenous injection in the hospital, with the patient continuing antibiotic therapy at home. If the endocarditis becomes more complex, such as when the infection fragments off and causes a series of strokes, or heart failure is occurring, then heart valve replacement surgery is often required.

Persons at risk for endocarditis can take preventive antibiotics before having any risky dental and medical work done. Antibiotics can prevent the survival of bacteria that may enter the bloodstream during these procedures.

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Discussion Comments
By otatop — On May 26, 2011

@Apunkin-My husband developed bacterial endocarditis after having a root canal. I wish his dentist had been as cautious as yours. He didn't have a history of heart problems either, and that's probably why he wasn't put on antibiotics. He recovered, but the infection left damage to his heart valve.

I agree with your dentist, "An ounce of prevention is worth a pound of cure."

By Apunkin — On May 24, 2011

My dentist obsessively practices what he calls endocarditis prophylaxis. He requires that every patient go on antibiotics before having any dental work done, even minor procedures.

I understand that logic for those with a history of heart problems or at risk, but I'm neither, and I don't like taking antibiotics without good cause. It just seems a little excessive to me.

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