What is Endocarditis?

What is Endocarditis?

Endocarditis is inflammation of the inner lining and valves of the heart; it is usually caused by a bacterial or fungal infection originating somewhere else in the body. Endocarditis is serious and if left untreated, can be fatal.

A fungal or bacterial infection can enter the bloodstream and move toward the heart. Once the infection has entered the heart area, inflammation and damage to the heart’s valves and lining can occur. People with a heart condition or artificial heart valves are at risk of developing an endocarditis infection.

Types of Endocarditis


The two main types of endocarditis, also known as infective endocarditis (IE), that affect the inner lining or valves of the heart:

  • Acute infective endocarditis. This infection develops quickly and could become fatal within a few days. The staphylococcus aureus bacteria cause acute bacterial endocarditis; some infections have been linked to strains of brucella and listeria. Acute infective endocarditis is a concern for people who have already had cardiac valve surgery, an artificial heart valve, or other cardiac devices such as a pacemaker. Unlike other inflammatory heart conditions, this inflammation is known to affect healthy heart valves.
  • Subacute or chronic IE (subacute bacterial endocarditis). This infection could take weeks or months to slowly develop. Streptococcal bacteria often cause subacute bacterial endocarditis. It is common for this infection to begin affecting damaged heart valves after having dental/gum surgery, and reproductive, urinary, or gastrointestinal tract surgeries.

Signs and Symptoms of Endocarditis


Signs and symptoms of endocarditis can differ between people. An existing heart condition could significantly increase the chance of contracting endocarditis. The type of germ causing the initial infection would indicate the type of inflammation present.
Some common endocarditis symptoms may include:

  • Joint and muscle pain
  • Shortness of breath and chest pain when breathing
  • Fatigue
  • Fever, chills, and flu-like symptoms
  • Night sweats
  • Swelling in the legs, feet, and stomach due to fluid retention
  • A newly developed or changed heart murmur

Some fewer common signs of endocarditis could include:

  • Weight loss
  • Blood in the urine
  • Tenderness near the spleen (under the left rib cage)
  • Painless red, purple, or brown spots on the soles of the feet or palms of the hands (Janeway lesions)
  • Painful red, purple, or dark patches or bumps on the tips of the fingers or toes (Osler nodes)
  • Purple, red, or brown spots on the skin, the whites of the eyes, or inside the mouth

What Causes Endocarditis?


Endocarditis is caused when bacteria, fungus, or other germ types enter the bloodstream and travel to the heart. Once there, the germs attach to damaged heart valves or tissue causing inflammation. The body’s natural immune system usually destroys harmful pathogens, but in cases of germs in the mouth, throat, intestines, or skin, these germs can enter the bloodstream and cause endocarditis.

People with compromised immune systems and those with pre-existing heart problems are more likely to acquire endocarditis. However, this inflammation is known to infect normal, healthy heart valves.

Risk factors for endocarditis can include:

  • Older adults. Endocarditis usually affects adults 60 years and older.
  • People with artificial heart valves. People with artificial heart valves or surgically implanted heart devices are more susceptible to developing infections of this sort.
  • Pre-existing heart damage. Medical conditions such as rheumatic fever can cause damage to heart valves; this increases a person’s risk of getting endocarditis and being susceptible to reinfection in the future.
  • Congenital heart defects. People who are born with heart defects are at a higher risk of contracting endocarditis.
  • Contaminated IV needles. Dirty needles used for illegal IV drug use, such as heroin or cocaine, can lead to endocarditis inflammation.
  • Dental hygiene. Poor dental hygiene can lead to endocarditis. Bacteria grow quickly in the mouth and can easily enter the bloodstream and travel to the heart, causing inflammation. It is recommended that people with certain heart conditions pre-medicate with an antibiotic before dental procedures.
  • Long-term catheter use. For people using indwelling catheters (long-term catheter use), their risk of developing endocarditis is increased.
  • Sexually transmitted diseases/infections. STDs/STIs such as gonorrhea and chlamydia allow bacteria to enter the bloodstream and travel to the heart easily. Candida fungal infections (yeast infections) can also cause endocarditis.
  • Sepsis. These infections which usually originate in the lungs, urinary tract, or gastrointestinal tract, can also cause endocarditis.

If you think you are at risk of developing endocarditis, inform your doctor for an early diagnosis.

What bacteria causes endocarditis?

Not all bacterial infections cause endocarditis. Endocarditis is usually caused by the staphylococcus aureus bacteria (staph) or streptococci (strep) bacteria. Sometimes endocarditis can be brought about by bacterial strains of either brucella or listeria. Endocarditis can affect healthy, normal heart valves compared to other heart inflammation conditions.

Endocarditis Risk Factors

Risk Factors

Some conditions could increase a person’s risk of contracting endocarditis. Some of these risk factors may be genetic, environmental, or behavioral. For instance:

  • Illegal drug use. Contaminated needles and syringes used for heroin and cocaine injections are a common source of bacterial infections leading to endocarditis.
  • Pre-existing heart conditions. There are medical conditions that can contribute to endocardial inflammation infections. Having had rheumatic fever in the past or a prior endocardial infection increases a person’s risk for future infections of this sort.
  • Artificial heart prostheses or devices. People with previous heart valve replacement surgery, implanted heart devices such as a pacemaker, or a heart transplant are at increased risk for developing bacterial infections that can lead to endocarditis.

Endocarditis Prevention


There are no exact rules for preventing endocarditis but knowing which preventive methods to follow or avoid is helpful information.

  • Good oral hygiene. Since our mouth and gums can harbor germs that could cause endocarditis, brushing and flossing your teeth regularly can help prevent the overgrowth of harmful bacteria. Good oral hygiene reduces your chance of contracting bacterial endocarditis more effectively than taking preventive antibiotics before dental procedures.
  • Avoid tattoos & body piercings. Contaminated needles could cause bacterial infections that can enter the bloodstream, travel to the heart, and cause an endocardial infection.
  • Preventive antibiotics. Preventive antibiotics are still recommended for people at the highest risk of contracting bacterial endocarditis. This would include people with artificial heart valves or other cardiac devices such as pacemakers, shunts, or regurgitation devices. Additionally, people with congenital heart conditions, unrepaired cyanotic congenital heart disease, or prior bacterial endocarditis infections are advised to take preventive antibiotics.
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Trust NewYork-Presbyterian for Pericarditis Care

NewYork-Presbyterian leads the country with the most heart specialists. NewYork-Presbyterian’s treatment of high-risk cases of endocarditis boasts significantly higher positive outcomes than other hospitals in the area. Our cardiac care experts are proficient in the most cutting-edge procedures available in the country.

With heart care treatment centers conveniently located throughout the New York City metropolitan area, including Westchester and Hudson Valley, our cardiovascular care services are close by, helping you avoid excess travel to meet your heart health needs.

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