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Infectious Endocarditis
Infectious Endocarditis
Alternative names
Endocarditis - infectious
Definition
Infectious endocarditis is an infection of the lining of the heart chambers and heart valves, caused
by bacteria, fungi, or other infectious agents.
Endocarditis is usually a result of bacteremia (bacteria in the blood), which is common during
dental, upper respiratory, urologic, and lower gastrointestinal diagnostic and surgical procedures.
The bacteria in the bloodstream can settle on damaged heart valves, and grow to create a
“vegetation” or clump of live bacteria. These growths may form infected clots that break off and
travel to the brain, lungs, kidneys, or spleen.
Many bacteria can cause endocarditis in patients with underlying valve problems, but an
organism commonly found in the mouth, Streptococcus viridans, is responsible for approximately
half of all bacterial endocarditis. Other common organisms include Staphylococcus aureus and
enterococcus. Less common organisms include pseudomonas, serratia, and candida.
Staphylococcus aureus can infect normal heart valves, and is the most common cause of
infectious endocarditis in intravenous drug users.
The health care provider may hear changing murmurs in the heart and detect an enlarged spleen
and mild anemia. Murmurs result from changes in blood flow across valves when clumps of
bacteria, fibrin and cellular debris, called vegetations, collect on the heart valves. The mitral valve
is most commonly affected, followed by the aortic valve.
• Congenital (present at birth) heart disease (atrial septal defect, patent ductus arteriosus,
and others)
• Prior rheumatic heart disease
• Cardiac valve anomalies (such as mitral insufficiency)
• Artificial heart valves
Since Streptococcus viridans is often found in the mouth, dental procedures are the most
common cause of bacterial endocarditis. This can put children with congenital heart conditions at
risk. As a result, it is common practice for children with some forms of congenital heart disease,
and adults with certain heart-valve conditions to start on antibiotics prior to any dental work.
Symptoms
• Fatigue
• Weakness
• Fever
• Chills
• Night sweats (may be severe)
• Weight loss
• Muscle aches and pains
• Heart murmur
• Shortness of breath with activity
• Swelling of feet, legs, abdomen
• Blood in the urine
• Excessive sweating
• Red, painless skin spots on the palms and soles (Janeway lesions)
• Paleness
• Nail abnormalities (splinter hemorrhages under the nails)
• Joint pain
• Abnormal urine color
• Red, painful nodes (Osler's nodes) in the pads of the fingers and toes
A history of congenital heart disease raises the level of suspicion. A physical examination may
show an enlarged spleen. The examiner may detect a new heart murmur, or a change in a
previous heart murmur. Examination of the nails may show splinter hemorrhages. Eye
examination may show retinal hemorrhages with a central area of clearing, called Roth's spots.
Treatment
If heart failure develops as a result of damaged heart valves, surgery to replace the affected heart
valve may be needed.
Expectations (prognosis)
Early treatment of bacterial endocarditis generally has a good outcome. Heart valves may be
damaged if diagnosis and treatment are delayed.
Complications
Call your health care provider if you note the following symptoms during or after treatment:
Prevention
Preventive antibiotics are often given to people at risk for infectious endocarditis before dental
procedures or surgeries involving the respiratory, urinary, or intestinal tract. Continued medical
follow-up is recommended for people with a previous history of infectious endocarditis.
Intravenous drug users are also at risk for this condition, because unsterile injecting practices
increase the exposure of the bloodstream to infectious agents. Treatment for addiction should be
sought. If this is not possible, use of a new needle for each injection, avoiding sharing any
injection-related paraphernalia, and use of alcohol pads to sterilize the injection site can reduce
risk.
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