Endocarditis, most often from a bacterial infection, inflames the lining of your heart valves and chambers. Treatment includes several weeks of antibiotics or other medicine and sometimes surgery. With quick, aggressive treatment, many people survive. Without treatment, endocarditis can be fatal.
Infective endocarditis (IE) is a potentially fatal inflammation of your heart valves’ lining and sometimes heart chambers’ lining. This occurs when germs (usually bacteria) from elsewhere in your body enter your bloodstream and attach to and attack the lining of your heart valves and/or chambers. Infective endocarditis is also called bacterial endocarditis (BE) or acute, subacute (SBE) or chronic bacterial endocarditis.
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Infective endocarditis causes growths (vegetations) on the valves, produces toxins and enzymes that kill and break down the tissue to cause holes in the valve, and spreads outside your heart and blood vessels. The resulting complications are:
Without treatment, endocarditis is a fatal disease.
Endocarditis happens to twice as many people assigned male at birth than people assigned female at birth. Also, people older than 60 make up more than 25% of cases.
People most at risk of developing bacterial endocarditis include those who have:
Endocarditis rarely happens in people whose hearts are healthy. According to the American Heart Association, about 47,000 people in the United States get an endocarditis diagnosis each year.
Signs of an endocarditis infection include:
Most of the time, a bacterial infection causes endocarditis. Dental procedures (particularly tooth extractions) and endoscopic examinations can cause bacteria to get into your blood. Sometimes, bacteria from your mouth, skin, intestines, respiratory system or urinary tract may be able to get into your bloodstream when you’re:
This can cause endocarditis. The bacteria rapidly form colonies, grow vegetation and produce enzymes, destroying the surrounding tissue and opening the path for invasion.
Normal heart valves are very resistant to infection. However, bacteria can attach to defects on the surface of diseased valves. Replacement heart valves are more prone to infection than normal valves.
Your healthcare provider will diagnose bacterial endocarditis after:
Diagnostic tests for endocarditis include:
Endocarditis can be life-limiting. Once you get it, you’ll needquick treatmentto prevent damage to your heart valves and more serious complications.
After taking your blood cultures, your healthcare provider will start you on intravenous (IV) antibiotic therapy. They’ll use a broad-spectrum antibiotic to cover as many suspected bacterial species as possible. As soon as they know which specific type of organism you have, they’ll adjust your antibiotics to target it. Usually, you’ll receive IV antibiotics for as long as six weeks to cure your infection.
Your provider will monitor your symptoms throughout your therapy to see if your treatment is effective. They’ll also repeat your blood cultures.
If endocarditis damages your heart valve and any other part of your heart, you may need surgery to fix your heart valve and improve your heart function.
After you complete your treatment, your provider will determine the sources of bacteria in your blood (for example, dental infections) and treat them. In the future, you should take prophylactic (preventive) antibiotics according to national guidelines.
Antibiotics treat bacterial endocarditis. For other types of endocarditis, you may need blood thinners or antifungal medicines. Medicines can have side effects, but this treatment is necessary to protect your life. Some people feel better within a few days of starting treatment. For others, it can take longer.
By practicing good oral hygiene habits every day, you can reduce your risk of bacterial endocarditis. Good oral health is generally more effective in reducing your risk of bacterial endocarditis than taking preventive antibiotics before certain procedures. Take care of your teeth and gums by:
The American Heart Association revised its guidelines for antibiotic prophylaxis (preventive antibiotics) before certain procedures to reduce the risk of bacterial endocarditis in high-risk people. The AHA no longer recommends antibiotic prophylaxis for non-dental procedures.
The organization considers endocarditis to be more likely a result of daily exposure to bacteria, rather than exposure during a procedure. Preventive antibiotic therapy may present greater risks than potential benefits if any.
Only people who have the highest risk for bacterial endocarditis will reasonably benefit from taking preventive antibiotics before certain procedures.
The highest risk group for bacterial endocarditis includes those with:
Tell your medical and dental providers you have heart disease that places you at a greater risk of developing endocarditis.
Take antibiotics before all dental procedures that involve manipulation of your gums or the periapical (roots) area of your teeth or perforation of your oral mucosa (tissue that lines the inside of your mouth).
Check with your medical provider about the type and amount of antibiotics you should take. Plan ahead to find out what steps you must take before the day of your procedure.
Carry a wallet identification card you can get from the American Heart Association with specific antibiotic guidelines.
You can expect to take antibiotics for two to eight weeks to get rid of your infection. Most people survive endocarditis when they get aggressive treatment, but your risk of endocarditis being fatal depends on:
Endocarditis is fatal without treatment.
Endocarditis can happen more than once. You’ll need to do your part to make sure you recover from endocarditis and stay well.
Contact your provider if you have symptoms of an infection. Don’t wait a few days until you have a major infection to seek treatment. Colds and the flu don’t cause endocarditis. But infections do, and they may have the same symptoms (sore throat, general body aches and fever). To be safe, contact your provider.
Call 911 if you think you’re having a stroke, which endocarditis can cause.
A note from Cleveland Clinic
With aggressive treatment, most people recover from endocarditis. Know the symptoms of endocarditis and contact your healthcare provider right away if you think you have it. Taking good care of your teeth and mouth can lower your risk of endocarditis. That includes daily care as well as visiting your dental provider on a regular basis.
Last reviewed by a Cleveland Clinic medical professional on 05/12/2022.
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