What is endocarditis?

Endocarditis is a rare but serious condition caused by infection of the inner lining of your heart. It usually involves one or more of your heart valves.

Endocarditis is also called 'infective endocarditis' or 'bacterial endocarditis'.

What are the symptoms of endocarditis?

Endocarditis symptoms can develop over a few days or several weeks.

Common symptoms include:

• fever (a high temperature), chills and night sweats
• tiredness or weakness
• muscle and joint aches and pains
• loss of appetite and recent weight loss
• shortness of breath
• headaches

Less common symptoms are:

• red or brown marks under your fingernails or toenails
• painless red spots on your palms or the soles of your feet
• painful lumps on your fingertips or toes
• chest pain
• back pain

If you develop any of these symptoms, especially if you are at risk of endocarditis, you should see your doctor as soon as possible.

Although many of these symptoms also have other causes, endocarditis must be diagnosed and treated rapidly.

When should I call an ambulance or go to the emergency department?

If you think that you have endocarditis, go to the nearest hospital emergency department.

If you have symptoms that are concerning, see your doctor as soon as possible.

What causes endocarditis?

Endocarditis is usually caused by a bacterial infection. It can sometimes be caused by a fungal infection. These germs can reach your heart:

• through your mouth after a dental procedure or after regular brushing and flossing
• after surgery or other medical procedures
• through your skin, digestive system or urinary system

When you have endocarditis, blood clots can form in your heart. The blood clots can also be infected — these are called 'vegetations'. Blood clots and vegetations can travel through your bloodstream to other parts of your body.

What can increase my risk of endocarditis?

Bacteria in your bloodstream are more likely to infect a heart that already has some damage. This damage might be congenital (present at birth) or caused by disease.

Heart conditions that can increase your risk of endocarditis include:

• heart valve disease or having an artificial heart valve
• certain types of congenital heart disease
• having had a heart transplant
• having an implanted heart device, such as a pacemaker or an implantable cardioverter-defibrillator
• certain types of cardiomyopathy
• previously having endocarditis

Your risk of endocarditis is also increased if you are more likely to have a bloodstream infection, such as from:

• poor oral hygiene and gum disease
• having an intravascular catheter (for example, for dialysis)
• intravenous drug use (injecting drugs)
• having an underactive immune system

How is endocarditis diagnosed?

Your doctor will ask about your symptoms and medical history. They will also examine you. Part of the examination will be listening to your heart for new or changing heart murmurs.

Tests that may be recommended include:

• multiple blood tests to check on the health of your organs and to look for infection
• a urine (wee) test
• an electrocardiogram (ECG) to check your heart
• an echocardiogram, which is an ultrasound of your heart
• a chest x-ray

How is endocarditis treated?

Endocarditis is a serious and complex condition. If diagnosed, you will need to be treated in hospital, at least to start with. You might need treatment in an intensive care unit (ICU).

You might see a range of doctors, including:

• a cardiologist (heart doctor)
• a microbiologist (someone who studies the germs that cause infection)
• an infectious diseases specialist
• a heart surgeon

Antibiotics

The main treatment for endocarditis is antibiotics. This will initially be given to you through an intravenous (IV) drip into a vein.

People with fungal infections need treatment with antifungal medicines.

Surgery

You may need surgery to remove infected tissue and to mend or replace your damaged heart valves.

If you have an infected heart device, such as a pacemaker, it will need to be removed.

Monitoring

You will need to have repeated check-ups and tests to monitor your progress.

Endocarditis can come back, so your health will be monitored closely for the next year or so. You'll learn how to lower your chance of reinfection and how to recognise if it occurs.

What are the complications of endocarditis?

There are several possible complications associated with infective endocarditis. Some of these are:

• heart valve damage
• heart failure
• kidney damage
• sepsis

Infected blood clots in your heart (vegetations) can break off and travel to other parts of your body, such as your:

• brain — causing a stroke
• lungs
• spleen
• joints

Can endocarditis be prevented?

If you are at risk of endocarditis, you should talk with your doctor to learn more about prevention.

Measures to help prevent endocarditis in people at risk include:

• good dental hygiene to reduce the risk of bacteria entering through your mouth
• regular dental check-ups
• avoiding body piercing, tattoos and intravenous drug use (injecting drugs)

If you are at risk of endocarditis, antibiotics may be recommended before certain dental or medical procedures. Talk to your doctor and dentist about the risks and benefits of taking antibiotics before procedures.

Resources and support

Information on heart conditions and support is available from the Heart Foundation.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available 24 hours a day, 7 days a week.