Endocarditis: Symptoms, Causes, Tests and Treatment

Infective endocarditis (IE) [also called bacterial endocarditis (BE), or depending on acuity acute or subacute or chronic bacterial ... ThinkyoumayhaveCOVID-19? Registerforadrive-thrutestingappointment(closedJan.1) Needavaccineorbooster? Scheduletoday ComingtoaClevelandCliniclocation? NonessentialsurgeriespostponedinOhiothroughJan.14,2022 Visitationandmaskrequirements Home / HealthLibrary / Disease&Conditions Endocarditis Appointments800.659.7822 Appointments&Locations TalktoaHeartNurse ContactUs Overview SymptomsandCauses DiagnosisandTests ManagementandTreatment Prevention Resources Endocarditis Overview SymptomsandCauses DiagnosisandTests ManagementandTreatment Prevention Resources BackToTop Overview Whatisbacterialendocarditis? Infectiveendocarditis(IE)[alsocalledbacterialendocarditis(BE),ordependingonacuityacuteorsubacuteorchronicbacterialendocarditis(SBE)]occurswhengerms(usuallybacteria)enterthebloodstreamandattachtoandattacktheliningoftheheartvalves.Infectiveendocarditiscausesgrowths(vegetations)onthevalves,producestoxinsandenzymeswhichkillandbreakdownthetissuetocauseholesonthevalve,andspreadsoutsidetheheartandthebloodvessels.Theresultingcomplicationsareembolismofmaterialfromthevegetations,leakyvalve,heartblockandabscessesaroundthevalve.Withouttreatment,endocarditisisafataldisease. Normally,bacteriacanbefoundinthemouth,ontheskin,intheintestines,respiratorysystem,andintheurinarytract.Someofthesebacteriamaybeabletogetintothebloodstreamwheneating,duringteethbrushingandwhenpassingstoolsandcauseendocarditis.Normalheartvalvesareveryresistanttoinfection,butdiseasedvalveshavedefectsonthesurfacewherebacteriamayattach.Valveprosthesis(replacementheartvalves)aremorepronetoinfectionthannormalvalves.Thebacteriarapidlyformcolonies,growvegetationsandproduceenzymes,destroyingthesurroundingtissueandopeningthepathforinvasion. Dentalprocedures(particularlytoothextractions)andendoscopicexaminationsareassociatedwithbacteriaintheblood,soprophylactic(preventative)antibioticsareadvisedforsomepatientswithvalvediseaseandallpatientswithvalvereplacements.IntravenousdrugabusersareathighriskfordevelopingIE. Whoisatriskfordevelopingbacterialendocarditis? Patientsmostatriskofdevelopingbacterialendocarditisincludethosewhohave: Acquiredvalvedisease(forexample,rheumaticheartdisease)includingmitralvalveprolapsewithvalveregurgitation(leaking)and/orthickenedvalveleaflets Anartificial(prosthetic)heartvalve,includingbioprostheticandhomograftvalves Previousbacterialendocarditis Certaincongenitalheartdefects Patientswithdevices,e.g.pacemakers Immunesuppressedpatients Patientswhoareintravenousdrugabusers Hypertrophiccardiomyopathy(HCM) AccordingtotheAmericanHeartAssociation,about29,000patientsarediagnosedwithendocarditiseachyear. SymptomsandCauses Whataresignsofinfection? Callyourdoctorifyouhaveanyofthesesignsofaninfection: Feverover100°F(38.4°C) Sweatsorchills,particularlynightsweats Skinrash Pain,tenderness,rednessorswelling Woundorcutthatwon'theal Red,warmordrainingsore Sorethroat,scratchythroatorpainwhenswallowing Sinusdrainage,nasalcongestion,headachesortendernessalonguppercheekbones Persistentdryormoistcoughthatlastsmorethantwodays Whitepatchesinyourmouthoronyourtongue Nausea,vomitingordiarrhea DiagnosisandTests Howisbacterialendocarditisdiagnosed? Thediagnosisofbacterialendocarditisisbasedonthepresenceofsymptoms,theresultsofaphysicalexaminationandtheresultsofdiagnostictests: Symptomsofinfection(seelistabove),particularlyafeverover100°F(38.4°C) Bloodculturesshowbacteriaormicroorganismscommonlyfoundwithendocarditis.Bloodculturesarebloodteststakenovertimethatallowthelaboratorytoisolatethespecificbacteriathatiscausingyourinfection.Bloodculturesmustbetakenbeforeantibioticsarestartedtosecurethediagnosis. Echocardiogram(ultrasoundoftheheart)mayshowgrowths(vegetationsonthevalve),abscesses(holes),newregurgitation(leaking)orstenosis(narrowing),oranartificialheartvalvethathasbeguntopullawayfromthehearttissue.Sometimesdoctorsinsertanultrasoundprobeintotheesophagusor“foodpipe”(transesophagealecho)toobtainaclosermoredetailedlookattheheart. Othersignsandsymptomsofbacterialendocarditisinclude: Emboli(smallbloodclots),hemorrhages(internalbleeding),orstroke Shortnessofbreath Nightsweats Poorappetiteorweightloss Muscleandjointache ManagementandTreatment Howisbacterialendocarditistreated? Onceendocarditisoccurs,quicktreatmentisnecessarytopreventdamagetotheheartvalvesandmoreseriouscomplications,suchasdeath.Assoonasthebloodcultureshavebeensecuredthepatientisstartedonintravenous(IV)antibiotictherapy(broadspectrum),coveringasmanyaspossibleofsuspectedbacterialspecies.Theantibioticsareadjustedtothesensitivityoftheorganismthatgrowsfromthebloodcultureassoonasthatisavailable.IVantibioticsisusuallygivenforaslongas6weekstocureoftheinfection.Symptomsaremonitoredthroughouttherapyandbloodculturesarerepeatedtodeterminetheeffectivenessoftreatment. Ifheartvalveandheartdamagehasoccurred,surgerymayberequiredtofixtheheartvalveandimproveheartfunction. Aftertreatmentiscompleted,thepatientshouldbeworkedupforsourcesofbacteremiaandthese(forexample,dentalinfections)shouldbetreated.Inthefuture,thepatientshouldtakeantibioticsprophylacticallyaccordingtoguidelines(seePrevention). Prevention Howcanbacterialendocarditisbeprevented? Traditionally,patientswhowereconsideredatriskofdevelopingendocarditis(suchasthoselistedaboveinthesection,“Whoisatriskofdevelopingbacterialendocarditis?”)wereadvisedtotakeantibioticsasapreventivemeasurebeforeanydental,gastrointestinalorurinarytractprocedure.TheAmericanHeartAssociationconductedareviewofthescientificliteraturetodeterminethevalueandeffectivenessofantibioticprophylaxis(preventiveantibiotics)beforesuchproceduresinreducingtheriskofbacterialendocarditis. Theyfoundthefollowinginformationtobeproventrue,andthereforerevisedtheguidelinesforbacterialendocarditisprevention. SummaryofInfectiveEndocarditis(IE)PreventionGuidelinesfromtheAmericanHeartAssociation* Endocarditisismorelikelyaresultofdailyexposuretobacteria,ratherthanexposureduringadental,gastrointestinaltractorgenitourinarytractprocedure.Theremaybegreaterrisksfrompreventiveantibiotictherapythanpotentialbenefitsifany. Youcanreducetheriskofbacterialendocarditisbypracticinggoodoralhygienehabitseveryday.Goodoralhealthisgenerallymoreeffectiveinreducingyourriskofbacterialendocarditisthanistakingpreventiveantibioticsbeforecertainprocedures.Takegoodcareofyourteethandgumsby: Seekingprofessionaldentalcareeverysixmonths Regularlybrushingandflossingyourteeth Makingsuredenturesfitproperly Learnmoreaboutgoodoralhygieneandheartdisease Notallendocarditiscanbeprevented.Callyourdoctorifyouhavesymptomsofaninfection(Seesignsofinfectionlistedabove).Donotwaitafewdaysuntilyouhaveamajorinfectiontoseektreatment.Coldsandthefludonotcauseendocarditis.Butinfectionsthatmayhavethesamesymptoms(sorethroat,generalbodyaches,andfever)do.Tobesafe,callyourdoctor. Onlythepeoplewhohavethehighestriskforbacterialendocarditiswillreasonablybenefitfromtakingpreventiveantibioticsbeforecertainprocedures.Thehighestriskgroupforbacterialendocarditisincludesthosewith: Anartificial(prosthetic)heartvalve,includingbioprostheticandhomograftvalves Previousbacterialendocarditis Certaincongenitalheartdiseaseincluding: Complexcyanoticcongenitalheartdiseasesuchassingleventriclestates,transpositionofthegreatarteries,TetralogyofFallot Unrepairedcyanoticcongenitalheartdisease,includingpatientswithpalliativeshuntsandconduits Congenitalheartdiseasethatiscompletelyrepairedbysurgeryorwithatranscatheterdevice.Endocarditispreventionisreasonableforatleast6monthsfollowingthedeviceimplant.AccordingtotheAmericanHeartAssociation,after6months,thereisinsufficientdatatomakerecommendationsforpreventiveantibiotictherapy. Repairedcongenitalheartdiseasewithdefectsstillremainingatthesiteornexttothesiteofaprostheticpatchorprostheticdevice Heartvalvediseasethatdevelopsafterhearttransplantation Importantly,theAHAnolongerrecommendsantibioticprophylaxisforgastrointestinalandgenitourinaryprocedures,suchasgastroscopy,colonoscopy,andcystoscopy. *Youcanviewtheguidelinesat:https://www.ahajournals.org/doi/full/10.1161/cir.0000000000000031 Ifyouareinthehighriskgroupabove,pleasefollowtheseadditionalguidelines: Tellyourdoctorsanddentistsyouhaveheartdiseasethatplacesyouatgreaterriskofdevelopingendocarditis. Takeantibioticsbeforethefollowingprocedures(asrecommendedbytheAmericanHeartAssociation): Alldentalproceduresthatinvolvemanipulationofgingivaltissueortheperiapicalregionofteeth,orperforationoftheoralmucosa. Proceduresoftherespiratorytractorinfectedskin,tissuesjustundertheskin,ormusculoskeletaltissue LinktoPreventionofBacterialEndocarditisWalletCard Checkwithyourdoctoraboutthetypeandamountofantibioticsyoushouldtake.Planaheadtofindoutwhatstepsyoumusttakebeforethedayofyourprocedure. Carryawalletidentificationcard.AwalletcardmaybeobtainedfromtheAmericanHeartAssociationwithspecificantibioticguidelines.VisittheirwebsiteorcallyourlocalAmericanHeartAssociationofficeornationally,1.800.AHA.USA1.* *Anewbrowserwindowwillopenwiththislink.Theinclusionoflinkstootherwebsitesdoesnotimplyanyendorsementofthematerialonthosewebsitesnoranyassociationwiththeiroperators.* Resources ClevelandClinicHeart,Vascular&ThoracicInstituteCardiologistsandSurgeons TheEndocarditisCenterprovidescomprehensivecaretotreatacuteepisodesofendocarditis;manageendocarditisnon-responsivetomedicaltherapies;andlongtermcaretopreventendocarditisfromoccurringinthefuture.TheEndocarditisCenterisaspecializedcenterinvolvingamulti-disciplinarygroupofspecialistsincludingcardiologists,cardiacsurgeons,infectiousdiseasespecialists,neurologistsandbehaviorhealthspecialists,withexpertiseintreatingendocarditis. CallCardiologyAppointmentsattoll-free800.223.2273,extension4-6697orrequestanappointmentonline. Resources: AmericanHeartAssociation,BacterialEndocarditis* AmericanHeartAssociation,BacterialEndocarditiswalletcard* AmericanHeartAssociation,PreventionofBacterialEndocarditis,Scientificstatement-Update* *Anewbrowserwindowwillopenwiththislink. Theinclusionoflinkstootherwebsitesdoesnotimplyanyendorsementofthematerialonthosewebsitesnoranyassociationwiththeiroperators. Share Facebook Twitter LinkedIn Email Print Getuseful,helpfulandrelevanthealth+wellnessinformation enews ClevelandClinicisanon-profitacademicmedicalcenter.Advertisingonoursitehelpssupportourmission.Wedonotendorsenon-ClevelandClinicproductsorservices. Policy RelatedInstitutes&Services Heart,Vascular&ThoracicInstitute(MillerFamily) Thelatestinformationaboutheart&vasculardisorders,treatments,testsandpreventionfromtheNo.1-rankedheartprogramintheUnitedStates. 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