Infective endocarditis symptoms, risks, diagnosis and treatment guidance.

Overview

What is infective endocarditis?

• Infective endocarditis (IE) is an infection affecting the heart's inner lining or the heart valves (small doors inside the heart that control blood flow)
• It is often caused by bacteria, and is sometimes called bacterial endocarditis
• Bacteria or other germs enter the blood and travel to the heart. These germs can stick to damaged heart valves or damaged heart tissue
• It is a serious condition and needs early treatment

How common is it in India?

Indian hospital studies show that IE is uncommon but serious. One Indian centre reported 79.6 cases per 100,000 hospital admissions.

Why is it important?

If not treated early, IE can damage heart valves, spread infection to other organs, cause stroke (block blood flow to the brain), heart failure or become life-threatening.

Who is at risk?

Risk of IE is higher in people with:

• Older age (older than 60 years)
• Artificial heart valves
• Damaged heart valves
• Implanted heart devices (e.g. pacemaker)
• Recent heart valve or device procedures
• Previous IE
• Birth-related heart problems
• Poor dental hygiene
• Long-term dialysis or IV lines
• Contaminated needles and syringes

Signs and symptoms

Common symptoms of IE include:

• Fever that does not go away
• Tiredness or weakness
• Aching joints and muscles
• Night sweats
• Chills
• Breathlessness
• Chest discomfort
• Swelling in feet, legs, or belly
• Weight loss or poor appetite
• New or changed heart murmur (whooshing sound in the heart)

Less common symptoms of IE are:

• Unexplained weight loss
• Blood in the urine
• Pain or tenderness below the left ribs
• Flat red, purple or brown spots on the palms or soles
• Painful red or purple bumps on the fingers or toes
• Tiny red or purple spots on the skin, inside the mouth or in the eyes

Possible complications

IE can lead to serious problems such as:

• Heart failure
• Damage to the heart valves
• Stroke (blood flow to the brain is blocked or reduced)
• Collection of pus (infection) in the heart, brain, lungs or other organs
• Blood clots in the lungs
• Kidney damage
• Swelling of the spleen

Warning signs:

If you have persistent symptoms of IE, visit your doctor as soon as possible

• Chills
• Fever
• Headaches
• Joint pain
• Shortness of breath

Tests to diagnose IE

Doctors may advise the following tests to diagnose IE:

• Blood tests: To find the germ causing infection
• Blood cultures: Special blood tests to identify bacteria
• Echocardiogram: Heart ultrasound to check valves
• Transesophageal echocardiogram (TEE): A more detailed heart scan done with a flexible tube inserted through the food pipe
• Electrocardiogram (ECG/EKG): A quick and painless test that checks the heart's electrical activity and heartbeat
• Chest X-ray: Shows the condition of the heart and lungs and helps detect heart swelling or spread of infection to the lungs
• Computed tomography (CT) scan or Magnetic resonance imaging (MRI): Detailed scans used to check if the infection has spread to the brain, chest or other parts of the body

Treatment

Many people with IE can be treated successfully with antibiotics. Some patients may need surgery to repair or replace damaged heart valves and get rid of the infection.

Medicines

• Antibiotics are used to treat IE caused by bacteria
• These medicines are usually given through a vein (IV) for several weeks
• Some patients may need to stay in the hospital initially
• Treatment may later continue at home if the condition improves
• If the infection is caused by fungi, antifungal medicines may be needed

Surgery

Some patients may need surgery if:

• The infection does not improve with medicines
• The heart valve is badly damaged
• The infection is caused by fungi

Surgery may help to repair or replace the damaged heart valve. The new valve may be artificial (mechanical), made from an animal (cow, pig) or human heart tissue.

Lifestyle tips to prevent IE

Prevention

You can lower your risk of endocarditis by taking care of your health and hygiene.

Watch for signs of infection. See your doctor if you have:

• Fever that does not go away
• Unusual tiredness
• Skin infections
• Cuts or wounds that do not heal properly

Take care of your teeth and gums

• Brush and floss regularly
• Visit your dentist for regular checkups
• Good oral hygiene helps prevent bacteria from entering the blood

Avoid self-medication with illegal injection drug use

• Using infected or unclean needles can allow germs to enter the bloodstream and increase the risk of IE

Preventive antibiotics

Some dental or medical procedures may allow bacteria to enter the bloodstream. Doctors may advise antibiotics before certain dental procedures for people at high risk of IE.

You may need preventive antibiotics if you have:

• A previous history of endocarditis
• An artificial (mechanical) heart valve
• Certain birth-related heart conditions
• Recent surgery for heart condition present since birth
• Heart transplant

Talk to your doctor or dentist to know if preventive antibiotics are needed before dental treatment.

Myths and facts

FAQs