Endocarditis

What causes endocarditis?

Endocarditis is an infection of the inner lining of your heart, often causing damage to your heart valves. It’s sometimes called infective or bacterial endocarditis.  

It’s a rare, but very serious condition. It happens when bacteria or fungi enter your bloodstream and attach to heart tissue. These germs enter the bloodstream in different ways, like through the mouth or skin. 

If your heart is already damaged there is a higher risk of endocarditis, as it’s easier for bacteria or fungi to settle and grow in the damaged areas. 

Am I at risk of endocarditis?

Your risk of endocarditis is higher if you:

• have heart valve disease
• have poor dental hygiene
• have had a heart valve replacement
• have had endocarditis before
• have certain types of congenital heart disease
• have a condition called hypertrophic cardiomyopathy
• inject drugs into your veins.

What are the symptoms of endocarditis?

Symptoms of endocarditis can develop slowly over weeks or sometimes months. In some cases, however, symptoms can come on suddenly.

The most common symptoms of endocarditis are:

• flu-like symptoms, like having a high temperature (38C or higher), tiredness, headaches, chills, a cough or sore throat
• fluttering or pounding feeling in your chest (palpitations)
• dizziness or feeling faint
• chest pain or discomfort
• not feeling hungry or unexplained weight loss
• being short of breath
• aching or painful muscles and joints
• an abnormal heart sound (heart murmurs).

Your symptoms may be an everyday illness, but it’s important that you get checked to make sure that it’s nothing more serious. 

Other rarer symptoms you may have include:

• small dark-coloured spots on your palms or the soles of your feet
• blood in your pee, which can look tea or cola coloured
• pee that is foamy or bubbly
• thin dark lines under your fingernails
• small lumps on your fingers or toes that might be painful.

Speak to your GP as soon as possible if you’ve been told you’re at high risk of developing endocarditis and you have any of the above symptoms. Watch out for flu-like symptoms with a high temperature (38C or higher).

How is endocarditis diagnosed?

In the early stages, endocarditis can look a lot like other common illnesses, which can make it tricky to spot. 

To help figure out what’s going on, your healthcare team may use a few different tests, such as:

• Blood tests to check for bacteria that may be causing the infection.
• An echocardiogram (echo) to look for signs of damage to your heart.
• An electrocardiogram (ECG) to see if your heart rhythm is normal.
• A chest X-ray to check for fluid build-up in your lungs.
• An MRI scan or CT scan to get clearer views of your heart.

Because endocarditis is a serious infection, doctors might decide to start treatment while they take steps to confirm the diagnosis.

How is endocarditis treated?

In the early stages of infection, you’ll usually need to be admitted to hospital straight away. You’ll be given antibiotics into your vein through a drip. If your symptoms and temperature improve, your doctor might decide to let you go home.

 After leaving hospital, treatment usually involves:

• Continuing your antibiotics, usually for up to 6 weeks.
• Regular check‑ins with your GP to see how you’re doing.
• Blood tests to make sure your body is responding to the treatment.

In some cases, you may need surgery to repair or replace a damaged heart valve. Sometimes it might also be necessary to repair or replace part of your aorta (the blood vessel that carries blood away from the heart).

What are the possible complications of endocarditis?

Sometimes, endocarditis can cause damage to your heart which may lead to heart failure. Endocarditis can also lead to a stroke. Whilst you are in hospital you will be monitored carefully and checked for these conditions. 

How can you reduce your risk of endocarditis?

You can lower your risk of developing endocarditis by:

• taking good care of your teeth and gums
• seeing your dentist regularly
• avoiding body piercings or tattoos
• washing your hands often and properly
• keeping cuts and grazes clean and being aware of skin infection signs
• being aware of endocarditis signs and symptoms
• contacting your doctor if anything concerns you.

Should you take antibiotics before dental treatment to prevent endocarditis?

Most people who are at higher risk of endocarditis will not need to take antibiotics before having dental work. However, a small number of people may be told to take antibiotics before having certain dental treatments.

It’s usually a shared decision by your dentist and doctor, where they consider your overall health and risks. If antibiotics are suggested, it’ll be for a good medical reason.

You may be advised to take antibiotics before certain dental procedures if you have: 

• a prosthetic heart valve, including a transcatheter valve
• had a valve repair using prosthetic material. 
• had endocarditis in the past
• a specific type of congenital heart disease (CHD), or any CHD which has been repaired with prosthetic material.

If you have questions or worries about antibiotics and dental procedures share them with your dentist or cardiologist.

Heart Helpline and other support

• Get in touch with our expert cardiac nurses through our Heart Helpline, which is open Monday to Friday, 9am to 5pm.
• Read Stuart’s story of adapting to a new normal after he unexpectedly developed endocarditis.
• Utilise The Improving Access to Psychological Therapies (IAPT) services across the country.
• Speak to others with heart conditions by joining a support group or online community.
• Sign up to our Heart Matters magazine and online information packed with health and lifestyle advice.