What is endocarditis?

Endocarditis is a rare but serious condition caused by infection of the inner lining of the heart. With prompt diagnosis and treatment, most people can recover, but the condition can be fatal.

What are the symptoms of endocarditis?

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

• a high temperature (fever), chills and night sweats
• muscle aches and pains
• shortness of breath
• coughing
• headaches
• chest pain
• blood spots in the eyes
• bleeding under the fingernails or toenails
• painless red spots on the palms
• painful lumps on the fingertips or toes
• low blood pressure and dizziness
• extreme tiredness and weight loss
• swelling in the feet or ankles

If you develop any of these symptoms, especially if you are at high risk, you should see your doctor as soon as possible. Although many of the symptoms also have other causes, endocarditis must be diagnosed and treated rapidly. About 1 in 3 people who develop endocarditis die within a year. Early diagnosis makes effective treatment much easier.

What causes endocarditis?

Endocarditis is usually caused by a bacterial infection. It is also called infective endocarditis or bacterial endocarditis.

Bacteria can reach the heart:

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

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

The following also increase the risk of developing endocarditis:

• surgery or other procedures in a hospital or clinic
• a problem with the valves in the heart
• an artificial heart or a pacemaker
• problems with the teeth and gums
• illicit drug or medicine misuse by injection
• an immune system that doesn't work as well as it should

When should I see my doctor?

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

If you develop any of the above symptoms, especially if you are at high risk, you should see your doctor as soon as possible or go to the nearest emergency department.

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How is endocarditis diagnosed?

Your doctor will consider your medical history and physical symptoms, and will examine you. You are likely to have:

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

You might also have other imaging tests such as a PET scan.

How is endocarditis treated?

Endocarditis is a serious and complex condition. If diagnosed, you will need to be treated in hospital, at least initially, and might be in an intensive care unit. You might see a range of doctors, including a cardiologist, a microbiologist, an infectious diseases specialist and a surgeon.

The main treatment for endocarditis is antibiotics, initially through an intravenous (IV) drip. You will have repeated blood tests, x-rays and other imaging tests to monitor your progress. Some people with endocarditis need surgery to remove infected tissue and to rebuild or replace damaged heart valves.

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

Can endocarditis be prevented?

Measures to help prevent endocarditis include:

• observing good hygiene practices in hospitals and health clinics
• observing good dental hygiene to reduce the risk of bacteria entering through the mouth
• for people at high risk of endocarditis, having preventative antibiotics before invasive dental procedures