Endocarditis – Symptoms and Causes

What is endocarditis?

Endocarditis is inflammation of the inner lining of your heart, called the endocardium. Generally it is caused by bacteria. When the inflammation occurs due to infection, the condition is called infective endocarditis. Endocarditis is  not common in people with healthy hearts.(1)

What are the symptoms of endocarditis?

The symptoms of endocarditis aren’t always severe, and they may develop gradually with time. In the early stages of endocarditis, the symptoms are similar to many other diseases. Because of this many cases go undiagnosed.

Many of the symptoms are same like cases of the flu or other infections, such as pneumonia. However, some people feel severe symptoms that appear suddenly. These symptoms may be due to inflammation or the related damage it causes.(2)

Following are the common symptoms of endocarditis:

Less common symptoms of endocarditis include:

Skin may also show some changes, including:

  • tender red or purple spots are seen below the skin of fingers or toes
  • tiny red or purple spots from blood cells that came out of ruptured capillary vessels, which generally appear on the sclera of the eyes, inside the cheeks, on the roof of the mouth, or on the chest

The signs and symptoms of infectious endocarditis show large variation from person to person. They can change over time, and they depend on the cause of your infection, heart health, and how long the infection has been present. If you have a history of heart problems, heart surgery, or previous endocarditis, you should consult your doctor without any delay if you have any of these symptoms. It’s particularly important to contact your doctor if you have a constant fever that will not goes down or you have unusual tiredness and don’t know why.

What are the causes of endocarditis?

The main cause of endocarditis is an excessive growth of bacteria. Although these bacteria normally live on the inside or outside surfaces of your body, they might enter inside to your bloodstream by eating or drinking. Bacteria could also enter through cuts or wounds in your skin or oral cavity. Your immune system normally fights off from germs before they cause any symptom, but this process doesn’t work in some people.

In the case of infective endocarditis, the germs travel through your bloodstream and into your heart, where they grow in number and cause inflammation. Endocarditis can also be caused by fungi or other microbes.

Eating and drinking aren’t the only ways that pathogens can enter your body. They can also enter into your bloodstream through:

Risk factors for endocarditis

Risk factors for developing endocarditis include the following:

  • injecting illegal intravenous drugs with a needle contaminated with microbes
  • scarring caused due to damage of heart valve, which allows bacteria or other pathogens to grow
  • tissue damage from suffering endocarditis in the past
  • having a heart defect
  • having an artificial heart valve replacement

How is endocarditis diagnosed?

Your doctor will check your symptoms and medical history before performing any tests. After this review, they’ll listen your heart sound by using a stethoscope.The following tests may also be performed:

Blood test

If your doctor suspects you have endocarditis, a blood culture test will be performed to confirm whether bacteria, fungi, or other microbes are causing it. Other blood tests can also tell about if your symptoms are caused by another condition, such as anemia.

Transthoracic echocardiogram

A transthoracic echocardiogram is a non-radiating imaging test performed to view your heart and its valves. This test uses ultrasound waves to create a picture of your heart, with the imaging probe placed on the front of your chest. Your doctor can use this imaging test to check out signs of damage or abnormal movements of your heart.

Transesophageal echocardiogram

When a transthoracic echocardiogram doesn’t give sufficient information to evaluate your heart correctly, your doctor might perform an additional imaging test called a transesophageal echocardiogram. This is done to view your heart via your esophagus.


An electrocardiogram (ECG or EKG) may be ordered to get a better view of your heart’s electrical activity. This test can determine an abnormal heart rhythm or rate. A technician will attach 12 to 15 soft electrodes to your skin. These electrodes are connected to electrical leads (wires), which are then connected to the EKG machine.

Chest X-ray

collapsed lung or other lung issues can lead to some of the similar symptoms as endocarditis. A chest X-ray may be performed to view your lungs and see if they’ve collapsed or if fluid has formed in them. A buildup of fluid is called pulmonary edema. The X-ray can help your doctor to find out difference between endocarditis and other conditions associated with your lungs.

How is endocarditis treated?


If your endocarditis is caused by bacteria, it will be treated with intravenous antibiotic therapy. Your doctor will suggest you to take antibiotics until your infection and associated inflammation are successfully treated. You will probably get these in a hospital for at least a week, until you show signs of improvement. You will need to continue antibiotic therapy upon discharge from the hospital. You may be able to switch to oral antibiotics later in your treatment. Antibiotic therapy usually takes up to six weeksTrusted Source to finish.


Long term infective endocarditis or damaged heart valves caused by endocarditis may need surgery to cure. Surgery may be performed to remove any dead tissue, scar tissue, fluid buildup, or debris from infected tissue. Surgery may also be performed to repair or remove your damaged heart valve, and replace it with either man-made material or animal tissue.

What are the complications associated with endocarditis?

Problems may occur from damage caused by your infection. These can include an abnormal heart rhythm, such as atrial fibrillationblood clots, other organ injury, and hyperbilirubinemia with jaundice. Infected blood can also lead to emboli, or clots, to traverse to other parts of your body.

Other organs that can be affected include:

  • kidneys, which may become inflamed, leading to a condition called glomerulonephritis
  • lungs
  • brain
  • bones, especially your spinal column, which may become infected, leading to osteomyelitis

Bacteria or fungi can flow from your heart and affect these areas. These microbes can also lead to abscess formation in your organs or other in your other body parts.

Another serious complications that can occur from endocarditis include stroke and heart failure.

How can endocarditis be prevented?

Maintaining a good oral hygiene and keeping regular dental appointments can help reduce the risk of bacteria growing up in your mouth and entering into your bloodstream. This reduces your risk of developing endocarditis from an oral infection or injury. If you’ve experienced a dental treatment that was followed up with antibiotics, make sure to take your antibiotics as prescribed.

If you have a history of congenital heart disease, a heart surgery, or endocarditis, carefully watch for the signs and symptoms of endocarditis. special attention and care is required for a persistent fever and unexplained fatigue. Consult your doctor immediately if you are experiencing any of these symptoms.

You should also avoid:

  • body piercings
  • tattoos
  • use of intravenous drug
  • any procedure that might cause germs to enter your bloodstream

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