E1. Endocarditis


Did you know that the walls of your heart are made up of three layers? The outer layer is called the epicardium, the middle layer is the myocardium, and the innermost layer is the endocardium. Inflammation of this innermost layer and of your heart valves is called endocarditis. Endocarditis is usually caused by a bacterial infection. Bacteria enter your bloodstream from another part of your body and attach to damaged areas in your heart. Because of this, you are more likely to develop endocarditis if you already have a damaged or artificial heart valve.

Some things that will increase your risk of developing endocarditis include: having had endocarditis in the past, previous surgery on your heart valves, recent dental surgery, or using intravenous drugs. Early symptoms of endocarditis may make you feel tired or feverish like you have the flu. Other symptoms include chills and sweating, feeling short of breath, and having pain in your joints. You may also notice red spots under your skin. It is important to report any symptoms to your doctor, as untreated endocarditis can lead to serious health problems like heart failure or stroke.

Treatment for endocarditis will usually include long-term antibiotic therapy. Use this condition center to learn more about endocarditis. You can keep up with the latest research, find questions to ask your doctor, and get tips to help you feel your best.


Endocarditis is an infection of the inner lining of the heart. It is typically caused by bacteria (or in rare cases fungi) from other parts of your body, for example your mouth or skin. These bacteria travel through the bloodstream and can attach to the inner surface of the heart where an infection can grow. If left untreated, the infection not only damages the heart valves and heart lining, but it can spread to other areas of the body and even cause a stroke.

Endocarditis is more common in people who have an artificial heart valve or pacemaker, and in those who had heart defects from birth that have been repaired with surgery. Endocarditis also is more common in people whose immune systems are weak, those on dialysis and those who use injected drugs.

Treatment includes a long course of antibiotics. Some people require heart surgery to remove the infection and repair the damage.

Individuals who have had endocarditis once are more likely to have it a second time. Also, they may need antibiotics before having dental treatments and other medical procedures to lower the risk of infection and getting endocarditis.


Endocarditis is caused by bacteria in the bloodstream that leads to infection and injury of a heart valve. Bacteria may enter the bloodstream due to infections in the skin, mouth, lungs, or urinary tract. Bacteria may also enter the bloodstream after certain procedures. Illicit intravenous drug use also is a source for bacteria.

Endocarditis may develop if enough bacteria attach to heart valves or other devices in the heart, such as pacemaker wires. Although normal heart valves are good at resisting infection, damaged or heart valves with abnormal structures are at higher risk for endocarditis.

Signs and Symptoms

The most common symptoms of Endocarditis are:

  • Fever
  • Chills
  • Sweats
  • General malaise

Your doctor also may identify a new or worsening heart murmur. If your heart valve is significantly affected, you may have shortness of breath and other symptoms of congestive heart failure .

Endocarditis involving valves on the left side the heart (aortic and mitral valves) may cause a stroke. This can occur if parts of the infection break off the valve and travel to the brain. Signs and symptoms of stroke include a sudden change in vision, speech, movement, or consciousness.

Some patients have with symptoms that have gone on for a while or that are vague. This is called “subacute” endocarditis.

Other signs and symptoms include dark marks on the palms and soles, or painful red marks on the hands and feet.

What Increases Your Risk?

If you have a normal heart, you have a low risk for endocarditis. But if you have a problem with your heart that affects normal blood flow through the heart, it is more likely that bacteria or fungi will attach to heart tissue. This puts you at a higher risk for endocarditis.

You have a higher risk of endocarditis if you have:

  • Had endocarditis in the past
  • Certain congenital heart defects
  • Abnormal or damaged heart valves from diseases like rheumatic fever
  • Hypertrophic cardiomyopathy
  • Artificial heart valve (or valves)
  • Device in your heart like pacemaker or defibrillator
  • Catheter (tube) in a blood vessel for a prolonged period
  • Hemodialysis for kidney failure, especially if done through a catheter
  • Intravenous illegal drug use
  • HIV

When to call your doctor

Talk to your health care professional if you have any signs of infection that last for many days, especially if you have a heart condition. Common signs:

  • Fever
  • Sweats (especially night sweats)
  • Chills
  • Rash on skin
  • Non-healing wound

You may also experience other symptoms that should prompt you to call your health care team:

  • Chest pain
  • Shortness of breath
  • Leg swelling
  • Fatigue
  • Body aches
  • Unexplained weight loss
  • Pain in your abdomen

In preparation for your health visit, write down your symptoms and note how long you have had them. Also, make a list of all your medical problems including any recent procedures like dental procedures. Make a list all the questions you want to ask your doctor.

Exams and Tests

If your doctor suspects you have endocarditis, he or she may order certain tests to confirm the diagnosis. Tests include:

  • Blood tests, in particular a “blood culture” to check for the presence of bacteria in your bloodstream. The results, which can take a few days to receive, also provide information about what medicine should be used to treat the type of bacteria causing the infection.
  • An ultrasound of the heart(transthoracic echocardiogram) to check for endocarditis. A probe is placed on your chest while you are lying down and images are taken. A physician looks closely at the heart valves to determine if they are infected. Infection of the valves may appear as a growth on the valve, which may not be working properly.

If the transthoracic echocardiogram fails to confirm an infection, you may have another type of heart ultrasound, called a transesophageal echocardiogram. For this procedure, you are given medications to help you relax. A probe is passed down the esophagus (food pipe). This provides clear images of the heart valves because the heart lies directly in front of the esophagus.


Treatment of endocarditis usually begins in the hospital under the care of an infectious disease specialist and a cardiologist. Antibiotics are the main treatment to kill the bacteria or fungus growing on the heart valve.

Treatment is started in the hospital with antibiotic medications that are given to the patient through a tube that delivers the dose to the body through the blood vessels known as veins. This tubing is called an intravenous line and this can be placed in a medium-sized vein in the arm or in a large vein in the neck. If the patient is very sick, intensive care may be necessary.

Principles of Treatment

The type and length of treatment depends on the following:

  • Type of valve infected (artificial valve or your own natural valve)
  • Type of organism infecting the valve (bacteria or fungi)
  • Symptoms and severity of illness

Treatment usually lasts 4-8 weeks and depends on the type of bacteria or fungus growing on the valve and the type of valve infected. Since the treatment can last up to eight weeks, you may complete the course of medications at home after you are stable and the fever has broken. When at home, you will likely have a nurse service come to administer the antibiotic medications.

Goals of Treatment

  • Remove organism causing the infection
  • Repair or replace damaged heart valves if needed
  • Treat complications

A cardiothoracic surgeon may be asked to surgically repair or replace your heart valve if there is a fungal infection or damage to the heart valve that causes your heart not to work properly. In some cases, surgery may also be needed to prevent a stroke.


If you are at high risk for developing endocarditis, you should talk with your doctor about getting antibiotics before having dental procedures or medical procedures.

Other general precautions to help prevent endocarditis are:

  • Maintain good dental health: Brush and floss your teeth regularly and keep up with regular dental checkups.
  • Avoid behavior that may lead to skin infections, such as injection of recreational drugs, body piercings or tattoos.

If you develop any infections or sores that do not heal properly, seek immediate medical attention.

Living With Endocarditis

Endocarditis is not a contagious infection. If you have endocarditis, you don’t have to stay away from people. You can use household utensils, toys or clothes as any member of the family. Remember that treatment with antibiotics is very important. You have to finish the whole treatment, no matter how long it is, because the risk of the infection coming back increases if the treatment is incomplete.

Your medication can have some side effects, depending on what antibiotic your physician gives you. The risk of another infection depends on your risk factors.

You will need a follow up with blood tests and echocardiogram after you complete the treatment to make sure that the infection has cleared from your bloodstream and to check your heart valves.

After the infection clears and if the echocardiogram shows good results, you may go back to your normal life.