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Heart, section through the middle
Heart, section through the middle


Heart, front view
Heart, front view


Janeway lesion - close-up
Janeway lesion - close-up


Janeway lesion on the finger
Janeway lesion on the finger


Heart valves
Heart valves


Definition:

Endocarditis is inflammation of the inside lining of the heart chambers and heart valves (endocardium).

See also:



Alternative Names:

Valve infection



Causes, incidence, and risk factors:

Endocarditis can involve the heart muscle, heart valves, or lining of the heart. Most people who develop endocarditis have heart disease of the valves.

Risk factors for developing endocarditis include:

  • Injection drug use
  • Permanent central venous access lines
  • Prior valve surgery
  • Recent dental surgery
  • Weakened valves

Bacterial infection is the most common source of endocarditis. However, it can also be caused by fungi. In some cases, no cause can be identified.



Symptoms:
  • Abnormal urine color
  • Chills (common)
  • Excessive sweating (common)
  • Fatigue
  • Fever (common)
  • Joint pain
  • Muscle aches and pains
  • Night sweats
  • Nail abnormalities (splinter hemorrhages under the nails)
  • Paleness
  • Red, painless skin spots on the palms and soles (Janeway lesions)
  • Red, painful nodes in the pads of the fingers and toes (Osler's nodes)
  • Shortness of breath with activity
  • Swelling of feet, legs, abdomen
  • Weakness
  • Weight loss

Note: Endocarditis symptoms can develop slowly (subacute) or suddenly (acute ).



Signs and tests:

Doctors might suspect endocarditis in people with a history of:

  • Congenital heart disease
  • Intravenous drug use
  • Recent dental work
  • Rheumatic fever

The health care provider may detect a new heart murmur , or a change in a previous heart murmur. Examination of the nails may show splinter hemorrhages .

An eye exam may show bleeding in the retina a central area of clearing. This is known as Roth's spots. There may be small, pinpoint hemorrhages (petechiae) in the conjunctiva . The fingertips may be enlarged, and the nails may appear curved. This is called clubbing.

Tests:



Treatment:

People with this condition will often need to be hospitalized at first to receive antibiotics through a vein (intravenously). Long-term antibiotic therapy is needed to get the bacteria out of the heart chambers and valves.

Patients will usually have therapy for 6 weeks. The antibiotic must be specific for the organism causing the condition. This is determined by the blood culture and the sensitivity tests.

Surgery to replace the heart valve is usually needed when:

  • The infection is breaking off in little pieces, resulting in a series of strokes
  • The person develops heart failure as a result of damaged heart valves
  • There is evidence of organ damage


Support Groups:



Expectations (prognosis):

Early treatment of endocarditis improves the chances of a good outcome. However, valve destruction or strokes can result in death.



Complications:

Calling your health care provider:

Call your health care provider if you notice the following symptoms during or after treatment:

  • Blood in urine
  • Chest pain
  • Fatigue
  • Fever
  • Numbness
  • Weakness
  • Weight loss without change in diet


Prevention:

People with certain heart conditions often take preventive antibiotics before dental procedures or surgeries involving the respiratory , urinary, or intestinal tract. Always ask your doctor if you think you may need them.

Those with a history of endocarditis should have continued medical follow-up.



References:

Mandell GL, Bennett JE, Dolin R. Principles and Practice of Infectious Diseases. 6th ed. London: Churchill Livingstone; 2005; pp 975-1022.

Karchmer AW. Infective Endocarditis. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. St. Louis, Mo: WB Saunders; 2007:chap 63.

Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007 Oct 9;116(15):1736-54.




Review Date: 9/3/2008
Reviewed By: D. Scott Smith, M.D., MSc, DTM&H, Chief of Infectious Disease & Geographic Medicine, Kaiser Redwood City, CA & Adjunct Assistant Professor, Stanford University.  Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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