What is Infectious Endocarditis and What Causes It? - Care+Wear

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What is Infectious Endocarditis and What Causes It?

We recently had a friend contract Endocarditis. Before his diagnosis, he had never heard of Endocarditis, and we felt it was something that many of our community members would want to learn more about! So we reached out to him to learn more about his experience. After learning more, we thought it would be beneficial to share what we learned with our community

What is Endocarditis?

Endocarditis is an infection of the valves of the heart. As a result, those people with structurally abnormal hearts (artificial heart valves, congenital heart defects, or previous heart surgery) are at risk. Likewise a history of illicit intravenous drugs or patients who recently had bacteria in their bloodstream (bacteremia) are at a significantly higher risk of contracting endocarditis.

Endocarditis is characterized by lesions, which are known as vegetations which contain bacteria, that are adherent to the valves in the heart. Once the vegetations stick to the valves, it may cause the bacteria to spread to other organs and cause infection in those organs as well. The diagnosis of endocarditis is based on clinical features, imaging of the heart with an ultrasound machine (echocardiogram), and blood cultures demonstrating the growth of the bacteria in the bloodstream. Because there are not normally bacteria or fungi in blood, blood cultures will typically show if there are any abnormal microorganisms in your blood.

If a bacterial infection is causing endocarditis, your doctor will prescribe one or more antibiotics for prolonged duration (typically 6 to 8 weeks). These antibiotics often have to be given by intravenous (IV) infusion directly into the bloodstream. The duration and intensity of treatment depends on the severity of the infection and the type of bacterial organism that is responsible for the endocarditis. Since treatment may last 6 to 8 weeks, generally, a PICC line will be inserted to receive IV treatment. In addition to medical therapy with IV antibiotics at times surgical options are required to repair or replace the infected heart valve.

Causes of Endocarditis

Risk factors for people who develop endocarditis have a:

  • Birth defect of the heart
  • Damaged or abnormal heart valves
  • History of endocarditis
  • New heart valve after surgery
  • Indwelling catheters
  • Chronic Hemodialysis
  • Immunosupressed state (HIV, Chemotherapy, etc)

Infective Endocarditis begins when germs enter the bloodstream and then travel to the heart.

  • A bacterial infection is the most common cause of endocarditis.
  • Endocarditis can also be caused by fungi, such as Candida.
  • In some cases, no cause can be found.

Germs are most likely to enter the bloodstream by:

  • Central venous access lines
  • Injection drug use, from the use of unclean (unsterile) needles
  • Recent dental surgery
  • Other surgeries or minor procedures to the respiratory tract, urinary tract, infected skin, or bones and muscles

    Symptoms of Endocarditis

    Symptoms of endocarditis may develop slowly or suddenly. Fever, chills, and sweating are frequent symptoms. These sometimes can be present for days before any other symptoms appear. They can also come and go or be more noticeable at nighttime. You may also have fatigue, weakness, and aches and pains in the muscles or joints. Other signs can include:

    • Small areas of bleeding under the nails (also known assplinter hemorrhages)
    • 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

    If you have these symptoms, please contact your health provider

    Exams and Tests to Help Determine Whether You Have Endocarditis

    There are several issues that your health provider may detect. Your health care provider may detect a new heart murmur, or a change in a past heart murmur. A murmur is an abnormal sound that your doctor will hear between beats of your heart when they listent to your heart during a physician exam. An eye exam may show bleeding in the retina and a central area of clearing. This finding is known as Roth's spots.

    Tests that may be done include:

    • Blood culture to help identify the bacteria or fungus that is causing the infection
    • Complete blood count (CBC), C-reactive protein (CRP), or erythrocyte sedimentation rate (ESR)
    • A routine echocardiogram or a transesophageal echocardiogram to look at the heart valves

    Treatment

    You may need to be in a hospital to receive IV antibiotics. Blood cultures and tests will help your provider choose the best antibiotic. You will then need long-term antibiotic therapy. People most often need therapy for 6 to 8 weeks to fully kill all the bacteria from the heart chambers and valves. The exact duration of antibiotics will be determined by your doctor. Antibiotic treatments that are started in the hospital will need to be continued at home. Surgery can be utilized to replace the heart valve.

    Outlook (Prognosis)

    Getting treatment for endocarditis right away improves the chances of a positive outcome. However, ignoring symptoms can result in more serious problems. Problems that may develop include:

    • Brain abscess (pocket of puss in the brain)
    • Further damage to the heart valves, causing heart failure
    • Spread of the infection to other parts of the body
    • Stroke, caused by small clots or pieces of the infection breaking off and traveling to the brain

    When to Contact a Medical Professional

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

    • Shortness of Breath
    • Chest pain
    • Fatigue
    • Fever
    • Numbness
    • Weakness
    • Weight loss without a change in diet
    • Or any other new or concerning symptoms

    How Can You Prevent Endocarditis?

    TheAmerican Heart Associationrecommends preventive antibiotics for people at risk for infectious endocarditis, such as those with:

    • Certain birth defects of the heart
    • Heart transplant and valve problems
    • Man-made (prosthetic) heart valves
    • Past history of endocarditis

    These people should receive antibiotics when they have:

    • Dental procedures that are likely to cause bleeding
    • Procedures involving the breathing tract
    • Procedures involving the urinary tract system
    • Procedures involving the digestive tract
    • Procedures on skin infections and soft tissue infections

    Not all cases of endocarditis can be prevented because we do not always know when a bacteremia occurs. However, there are steps that can be taken to lower the risk and likelihood of contracted endocarditis.

    For patients whose heart conditions put them at the highest risk for adverse events from infective endocarditis, theAmerican Heart Associationrecommends antibiotics before certain dental procedures. However, for most patients, antibiotics are not needed. Taking proper care of your teeth and gums is the single most important preventative measure you can take. The mouth is a common source of bacteria that can cause infection. Keeping your mouth clean and healthy while maintaining regular dental care will also help reduce the chance of bacteremia from routine daily activities. Early treatment of endocarditis symptoms will help reduce the severity of future treatments.

    Care+Wear is committed to helping patients get back to living their lives. We hope this blog post on endocarditis was helpful for those hoping to learn more about it. If you know any patients with endocarditis and receiving treatment through a PICC line, you can check out our fashionablePICC line coversthat help secure and protect your PICC line.

    We’d love to hear what else you want to learn about as we’re always looking for more great blog post topics.

    Reviewed by :
    Gregory Weingart, MD, a practicing ER physician, andAssistant Professor at the Eastern Virginia Medical School

    11 Responses

    Christopher

    Christopher

    April 12, 2023

    It is scary and me not knowing if I’m sick or need to go back to the doctor is hard to know with COVID going around and I just got out a month ago I lost a lot of wait when I was in the hospital the pounds I did have turned out to be just water wait didn’t know until I had to walk soon as I got out of the hospital I woke up with a sore throat and small headache I all ready don’t have wait on me like I should so fare this is what I realized and after I got out the hospital my joints been hurting so what could this mean after they said I could go home and the infection on the heart valve is gone and out of my bloodstream what could this mean

    Shelley

    Shelley

    September 17, 2021

    I had a double mechanical valve procedure a left ventricular resection and a shave off my ao Rita I have a picc line.
    I recently had a small procedure the surgery went ok but he decided to give me metronidazole whilst I’m on heavy doses of warfarin my I really went above 10 i was in and out the hospital for a week I had a major pr bleed they sent me home told me to stop warfarin and suck it up until my INR diminishes I went home I was losing so ,u h blood I called the surgeon mother cardiologist and anticoagulation I got no response then I get a text message from my GP stating my haemoglobin dropped again.
    BY THE TIME THE DISTRICT NURSE ARRIVED I WAS SERIOUSLY ILL I DIDN’T WANT TO GO AS EVERYONE HAD LET ME DOWN.
    The district nurse had a duty of care so I went back into hospital my HB dropped to 42 I had to have a blood transfusion of 4 units then on A heparin infusion.
    I have been in and out of hospital a lot but they told me I lost about 5 pints of blood in 4 days.

    My question is I have a picc line I have low. HB of 85 I had nerve degenerative surgey on Wednesday I’ve been vomiting a high temperature which just proceeded just after she took blood and flushed my picc line I’m only on bridging heparin at present am in danger fever bones ache sweats I suffer with epilepsy I’ve had a seizure due to the fever I cannot take anti fever medicine the nurse said it was just a bit tiny red but several hours later I much worse my pulse is normally 52-58 it’s 91

    Do you have any answers to my questions thank you for taking the time to read this
    With
    Kindest
    Regards
    Shelley

    Lisa

    Lisa

    December 04, 2020

    One more thing, on top of the Endocarditis I also had contracted pneumonia. The longer I waited, the more my body got sick with different, very serious illnesses. With Covid especially, again, pay attention to your body! I hope I was helpful.

    Lisa

    Lisa

    December 04, 2020

    @Tony…
    Yes, absolutely get a second opinion. They may need to do heart surgery to fix your heart valve. But they should not have let you leave the hospital! Please go because as my doctor told me, “Get your ass to the hospital to get admitted because that shit will kill you!”. Don’t play with your life Tony! Get your butt back to the hospital, NOW! You’re in my prayers and thoughts. Bon chance! Sava!

    Lisa

    Lisa

    December 04, 2020

    Hello…
    I was diagnosed with endocarditis back in January 2018. I didn’t have symptoms really except for “night sweats”, which ocured all of the time slong with muscle aches. One evening I was awakened by my heart beating like crazy, sweats and the shakes. I thought I was having a heart attack. My husband called paramedics and when they arrived, one of them told me that I was having a panic attack. My retort to him was, “no, I’ve had true panic attacks and am currently being treated for them”. He insisted that’s what is was and off to the hospital we went. Right as we entered the E.R. I began having extremely violent seizures and almost fell off of the gurney. The paramedics that brought me there began laughing at me and my husband snapped on them, telling them his wife is having a seizure! Upon my third seizure two nurses began wheeling me back, holding me down and began to scream at me to hold still and STOP moving! I felt so helpless. After the seizures stopped I couldn’t move from my neck down and my speach changed. I didn’t sound like myself at all. I was scared to death. I could feel EVERYTHING, just paralyzed completely. The doctor was a complete buttwad also. They ran all sorts of tests including a spinal tap for meningitis. By the next evening after being admitted to this extremely unprofessional hospital, I began to regain feeling and eventually was able to walk with my husband’s assistance. Needless to say we broke out. Two days later I got a call from the doctor and they told me I had contracted Endocarditis and the infection spread to my brain. I was scared out of my mind. I called my family doctor and he immediately admitted me and they began IV antibiotics. Upon my discharge I was not sent home with any antibiotics which I thought would’ve been a necessity. After that, I was running a low fever with aches and pains with headaches and sometimes night sweats. I was, again, at the ER for something else and when the doctor checked my heart she said she heard a murmur but said nothing further after that. I’m not sure if I have contracted Endocarditis yet again but I’m scared to ever do a repeat of that. I literally thought I was going to die, that’s what it felt like. Whenever I mention this to a new doctor they ask me if I used IV drugs, that’s their first question. In conclusion, I’d like to share with you to please pay attention to your body. I wouldn’t want ANYONE to go through that experience. And thank you if you’re still reading this. I know it was long, but, it’s a very important share. Take care and be safe.

    Daniel Largiader

    Daniel Largiader

    November 02, 2020

    I recently had Endocarditis twice over a 7 month period. I contracted Endocarditis because of Illicit drug use in late November 2019… I thought I had the flu and got so sick to the point I could barely walk and had also contracted pneumonia. I didn’t go to the hospital until December 8th. I eventually had a breathing tube stuck all the way down into my lungs and was then put into an induced coma for almost 3 weeks. When I woke I was 50 pounds lighter and still barely able to breathe. If I had gone in on December 9th I would be dead. They ended up giving me 8 weeks of antibiotics and that was that.

    However, in late May 2020, during the pandemic, I knew I had it again based on the symptoms. This time the came faster, and I was BARELY able to walk just a few days after I thought I had it again. This time they replaced both my Tricuspid and Aortic valves. The morning after surgery my heart stopped 3 different times and they had to do an emergency surgery to put a Pacemaker in me.

    I am 29. I have a foot and a half long scar in the middle of my chest, as well as 5 scars where they put tubes to drain my lungs and chest. Again, I am 29, which is a shame and I feel pathetic. But they saved my life. I urge anyone who uses IV drugs to never use a needle more than once, but the better advice would be to never use them EVER again. I thought I was invincible and something like this could never happen to me. But it did. Thank god I have a loving family that took care of me and took care of everything else that was going on during this. Also, thank god for Medicaid or I would have medical bills reaching almost $100,000.

    I hope someone reads this and will learn from my story. I know I will likely die from this disease because those who get it twice will eventually get it a third time 69 percent of the time I am told. They also said they will not operate on me for at least another 5 years, so hopefully I make it that long.

    All I can do is pray… God Bless.

    Elsy

    Elsy

    June 24, 2020

    My husband has a blood infection that has affected 3 of his heart valves, and infection on lumbar 2 and 3, plus gangrene in one of his left toes; he in the hospital with 2 IV antibiotics for a while. I am devastated.

    Debbie Brown

    Debbie Brown

    June 24, 2020

    My fiance is in the hospital as we speak. In March I found him unresponsive and barely breathing. I begged the ambulance to take him to OHSU but because of the situation the had to take him to zPORTLAND ADVENTIST. Not my hospital of choice for sure. He was admitted with extremely high Ammonia levels and fever. Hed had a TIPS procedure 2016 following being hit by a drunk driver. Hence the ammonia levels. The ICU doctor calls and said they were not treating the fever (103) they hadnt given him anything for the ammonia levels either. Had to threaten them with attorneys if the didnt give him Lactose and Tylenol. He was on a Ventilator too. Diagnosed with Endocarditis the dictor calls to find out if he shoots hid drugs into his ankles. He had cellulitis on his ankles. I didnt know what the doctor wss talking about. He assumed since we are homeless that my fiance is an IV drug user. They discharged him with bacterial Endocarditis. Before the discharge they drained 5.5 litres of flyid from his chest. An hour later they put him in a cab. Hes fighting for his life now. Due to the delay and down grade in his health he cannot have a valve replacement. We have to rely on iv antibiotics and pray it takes away the vegitation from his aortic valve. Sone folks should never be allowed to practice medicine. They tried to play God, and decided he was a drug user which he is not. His 61st birthday is in 10 days. Will he make it? I dont know. Im hysterical, pissed off, and borderline suicidal. I dont know what im going to do if he doesnt make it. You see I was left with a TBI following the accident with the drunk driver. I have no coping skills. If he dies they will have surely killed me as well. The damage that hospital caused is criminal, the other Hospital OHSU is scrambling to correct the damage. But they are only human, and they have no magic to fix this. Im devastated. Please pray for us. Thank you.

    Christine Brown

    Christine Brown

    March 08, 2020

    I lost my husband in January 2017, he had a replacement heart valve 3 years previous. He developed endocarditis, the first signs we had that anything was wrong was when he started being sick on the Saturday, we visited the doctors on the Monday as he was still vomiting, went back Tuesday morning for blood tests, waited until 6pm that day for doctor to get back to us to say my husband needed to ho into hospital, i went into the bedroom to tell him and i could see he had had a stroke. Phoned the ambulance, taken to Whiston hospital. Had in excess of 20 ischemic strokes during the night. Had scan Wednesday pm found out he had endocarditis got line into him and started on antibiotics. Thursday am he went into a coma, i was then told he had sepsis and his organs were shutting down. He died at 6.40pm that evening. He was a very young 67 year old. This is how quickly you can go from celebrating your birthday one Thursday fit and well and then being dead the following Thursday. We have no idea how he contracted this and after his valve replacement we had never been warned that he was at greater risk and what to look out for. Needless to say this has left me devastated losing him like this. More should be told to those having heart valve replacements.

    Frances Hoult

    Frances Hoult

    January 23, 2019

    8 years ago I was going to the Drs almost every week with severe headaches.I was given pain killers . It got to a point where I couldn’t eat and I lost over 2 stone in weight. I had private health care and was referred to a neurologist. I had several CT scans and MRI scanns on my head to no avail.it wasn’t until I had an echo that it was picked up as my heart was beating over 200 beats .I was absolutely petrified as I could hardly breathe. I was then rushed off to Glenfield Hospital in Leicester where I had major surgery as I had infective endocarditis and had a new aortic valve inserted. I am very lucky to be alive. I was in intensive care for 2 weeks hdu for another week and back to Royal Derby for 4 more weeks for IV antibiotics. I am still traumatized by it at times and suffer with depression as well as being on Keppra for 8 years. I feel that I was neglected by the Drs at Park Surgery at Heanor. Changed my Drs since then. But I don’t feel the same person I was before this terrible mistake by the Drs.

    Tony

    Tony

    April 02, 2020

    I have just come out of hospital with iendercardies and I have a heart that has a value that does not close proper should I bee woried

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