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Infectious endocarditis - MedlinePlus Medical Encyclopedia
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Infectious endocarditis

Contents of this page:

Illustrations

Heart, section through the middle
Heart, section through the middle
Heart, front view
Heart, front view
Infective endocarditis
Infective endocarditis
Janeway lesion on the finger
Janeway lesion on the finger

Alternative Names    Return to top

Endocarditis - infectious

Definition    Return to top

Infectious endocarditis is an infection of the lining of the heart chambers and heart valves that is caused by bacteria, fungi, or other infectious substances.

See also:

Causes    Return to top

Endocarditis is usually a result of a blood infection. Bacteria or other infectious substance can enter the bloodstream during certain medical procedures, including dental procedures, and travel to the heart, where it can settle on damaged heart valves. The bacteria can grow and may form infected clots that break off and travel to the brain, lungs, kidneys, or spleen.

Most people who develop infectious endocarditis have underlying heart disease or valve problems.

However, an organism commonly found in the mouth, Streptococcus viridans, is responsible for about 50% of all bacterial endocarditis cases. This is why dental procedures increase your chances for developing this condition. Such procedures are especially risk for children with congenital heart conditions. As a result, it is common practice for children with some forms of congenital heart disease and adults with certain heart-valve conditions to take antibiotics before any dental work.

Other common culprits include Staphylococcus aureus and enterococcus. Staphylococcus aureus can infect normal heart valves, and is the most common cause of infectious endocarditis in intravenous drug users.

Less common causes of infectious endocarditis include pseudomonas, serratia, and candida.

The following increase your chances for developing endocarditis:

Intravenous drug users are also at risk for this condition, because unsterile needles can cause bacteria to enter the bloodstream.

Symptoms    Return to top

Symptoms of endocarditis may develop slowly (subacute) or suddenly (acute). Fever is the classic symptom and may persist for days before any other symptoms appear.

Other symptoms may include:

Exams and Tests    Return to top

The health care provider may hear abnormal sounds, called murmurs, when listening to your heart with a stethoscope.

A physical exam may also reveal:

A history of congenital heart disease raises the level of suspicion. An eye exam may show bleeding in the retina a central area of clearing. This is known as Roth's spots.

The following tests may be performed:

Treatment    Return to top

You will be admitted to the hospital so you can receive antibiotics through a vein. Long-term, high-dose antibiotic treatment is needed to get rid of the bacteria. Treatment is usually given for 4-6 weeks, depending on the specific type of bacteria. Blood tests will help your doctor choose the best antibiotic.

Surgery may be needed to replace damage heart valves.

Outlook (Prognosis)    Return to top

Early treatment of bacterial endocarditis generally has a good outcome. Heart valves may be damaged if diagnosis and treatment are delayed.

Possible Complications    Return to top

When to Contact a Medical Professional    Return to top

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

Prevention    Return to top

Preventive antibiotics are often given to people at risk for infectious endocarditis before dental procedures or surgeries involving the respiratory, urinary, or intestinal tract. The American Heart Association recommends antibiotics before a dental procedure if you have:

Continued medical follow-up is recommended for people with a previous history of infectious endocarditis.

Persons who use intravenous drugs should seek treatment for addiction. If this is not possible, use a new needle for each injection, avoiding sharing any injection-related paraphernalia, and use alcohol pads before injecting to reduce risk.

References    Return to top

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.

Update Date: 4/28/2008

Updated by: Mark Levin, MD, Division of Infectious Disease, MacNeal Hospital, Berwyn, IL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician 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. Copyright 1997-2009, A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.


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