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Endocarditis

Valve infection; Staphylococcus aureus - endocarditis; Enterococcus - endocarditis; Streptococcus viridans - endocarditis; Candida - endocarditis

Endocarditis is inflammation of the inside lining of the heart chambers and heart valves (endocardium). It is caused by a bacterial or, rarely a fungal infection.

Images

Heart, section through the middle
Heart, front view
Janeway lesion - close-up
Janeway lesion on the finger
Heart valves

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Causes

Endocarditis can involve the heart muscle, heart valves, or lining of the heart. Some people who develop endocarditis have a:

Endocarditis begins when germs enter the bloodstream and then travel to the heart.

Germs are most likely to enter the bloodstream during:

Symptoms

Symptoms of endocarditis may develop slowly or suddenly.

Fever, chills, and sweating are frequent symptoms. These sometimes can:

You may also have fatigue, weakness, and aches and pains in the muscles or joints.

Other signs can include:

Exams and Tests

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 finding is known as Roth spots. There may be small, pinpoint areas of bleeding on the surface of the eye or the eyelids.

Tests that may be done include:

Treatment

You may need to be in hospital to get antibiotics through a vein (IV or intravenously). Blood cultures and tests will help your provider choose the best antibiotic.

You will then need long-term antibiotic therapy.

Surgery to replace the heart valve is often needed when:

Outlook (Prognosis)

Getting treatment for endocarditis right away improves the chances of a good outcome.

More serious problems that may develop include:

When to Contact a Medical Professional

Call your provider if you notice the following symptoms during or after treatment:

Prevention

The American Heart Association recommends preventive antibiotics for people at risk for infectious endocarditis, such as those with:

These people should receive antibiotics when they have:

Related Information

Culture-negative endocarditis
Blood clots
Arrhythmias
Atrial fibrillation or flutter
Glomerulonephritis
Stroke
Brain abscess
Gonorrhea
Aortic valve surgery - minimally invasive
Aortic valve surgery - open
Mitral valve surgery - minimally invasive
Mitral valve surgery - open
Heart valve surgery - discharge

References

Baddour LM, Freeman WK, Suri RM, Wilson WR. Cardiovascular infections. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 73.

Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation. 2015;132(15):1435-1486. PMID: 26373316 www.ncbi.nlm.nih.gov/pubmed/26373316.

Fowler VG, Bayer AS, Baddour LM. Infective endocarditis. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 76.

Fowler VG, Scheld WM, Bayer AS. Endocarditis and intravascular infections. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 82.

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Review Date: 12/1/2018  

Reviewed 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, Boston, MA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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