(IE; Bacterial Endocarditis; Fungal Endocarditis)

Definition

Infective endocarditis (IE) is an infection of the inner surface of the heart. It is common for IE to develop on the heart valves. IE can be a life-threatening infection. It can also cause lasting damage to the heart. This can lead to health problems later on, such as heart failure.

Infective Endocarditis
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Clumps of bacteria can also form in the heart with IE. These clumps can break off and travel through the blood to other areas of the body. It may block blood flow to important organs such as the brain, kidneys, or lungs.

Causes

IE may be caused by:

  • Bacteria—most common
  • Fungus

The germs may be part of the normal environment in your mouth or on your skin. However, a cut in the mouth or skin will allow the germs to enter the blood. When the germs reach the heart, they stick to a surface. There, they can grow and damage nearby tissue. Certain conditions can make it easier for germs to stick in the heart:

  • Scarred or faulty heart valves
  • Heart conditions that slow blood flow or allow blood to pool
  • Weak immune system

Risk Factors

The risk of IE is higher with:

  • Heart valve disease—scarring can happen from rheumatic fever or other health problems
  • A heart problem you were born with
  • Prior IE
  • Disease of the heart muscle—cardiomyopathy
  • Having an artificial heart valve
  • IV drug misuse—risk is higher if needles are shared
  • Poor oral health
  • HIV infection
  • Diabetes
  • Prior procedures such as a bronchoscopy

Symptoms

Symptoms range from mild to serious. Factors that can influence symptoms include:

  • Exact cause of the infection
  • Amount of infection that's in your blood
  • Structural problems of the heart
  • How well your body can fight infection
  • Overall health

General symptoms may include:

  • Fever
  • Chills
  • Tiredness
  • Weakness
  • Weight loss without trying
  • Lack of hunger
  • Aches in your muscles or joints
  • Coughing
  • Problems with breathing
  • Little red dots on the skin, inside the mouth, or under the nails
  • Bumps on the fingers and toes

Diagnosis

You will be asked about your symptoms and health history. A physical exam will be done. The doctor will listen to your heart for a murmur. Testing will include:

Treatment

The first goal of treatment is to stop the infection. This will decrease the chance of lasting problems. Further treatment may be needed if the infection caused damage to the heart.

Medicine

Antibiotics will help to fight the infection. The type will depend on what exact germ is causing the infection.

It may first be given through an IV at the hospital. The medicine may them be continued as pills at home. Treatment may last for up to 6 weeks.

Surgery

Surgery may be needed to:

  • To remove infected tissue
  • To fix any heart or valve damage
  • To treat infections that continue despite treatment

Prevention

IE is not common. Some people may have a higher risk. If you have a risk of IE the following may help decrease chance of an infection:

  • Tell your dentist and doctors if you have any heart conditions.
  • Maintain good oral health:
    • Brush your teeth 2 times a day.
    • Floss once a day.
    • Visit your dentist for a cleaning at least every 6 months or as advised.
  • See your dentist if dentures cause discomfort.
  • Get medical help right away if you have symptoms of an infection.
  • Antibiotics may be needed before and after certain dental and medical procedures. This may only be advised for people with high risk of IE.

RESOURCES

American Heart Association  https://www.heart.org 

Mouth Healthy—American Dental Association  https://www.mouthhealthy.org 

CANADIAN RESOURCES

Canadian Dental Association  http://www.cda-adc.ca 

Heart and Stroke Foundation of Canada  https://www.heartandstroke.ca 

References

Antibiotic prophylaxis prior to dental procedures. American Dental Association website. Available at: https://www.ada.org/en/member-center/oral-health-topics/antibiotic-prophylaxis. Updated August 5, 2019. Accessed January 7, 2019.

Infective endocarditis. American Heart Association website. Available at: https://www.heart.org/en/health-topics/infective-endocarditis. Accessed September 6, 2019.

Infective endocarditis. EBSCO DynaMed Plus website. Available at:  https://www.dynamed.com/topics/dmp~AN~T113919/Infective-endocarditis  . Updated May 21, 2019. Accessed September 6, 2019.

Thanavaro KL, Nixon JV. Endocarditis 2014: an update. Heart Lung. 2014;43(4):334-337.

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