Infective endocarditis
Also called: Bacterial endocarditis, IE
A bacterial (occasionally fungal) infection of the heart's inner lining, usually a valve. Clumps of bacteria (vegetations) destroy the valve and can break off to cause strokes and abscesses.
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Causes
- Staphylococcus aureus
- Viridans streptococci from the mouth
- Enterococci
- Fungi (rare)
Risk factors
- Artificial heart valves
- Previous endocarditis
- Damaged or congenitally abnormal valves
- Injecting drug use
- Intravenous lines and haemodialysis
- Poor dental health
Symptoms
- Fever and sweats
- Tiredness and weight loss
- New heart murmur
- Small haemorrhages under nails, painful finger nodules
- Symptoms of emboli: stroke, limb or abdominal pain
Diagnosis — tests and examinations
- At least three sets of blood cultures before antibiotics
- Echocardiography (transoesophageal is most sensitive)
- Modified Duke criteria
- PET-CT for prosthetic valves
Treatment
Medicines and medical treatment
- Prolonged intravenous antibiotics, usually 4–6 weeks, chosen by culture results
Operations and procedures
- Valve surgery for heart failure, uncontrolled infection, abscess or large vegetations
Self-care, home remedies and lifestyle
- Excellent dental hygiene and regular dental check-ups
- Avoid skin piercing and tattoos if high risk
Possible complications
- Valve destruction and heart failure
- Stroke and emboli
- Heart abscess
- Kidney damage
- Death
Prevention
- Good oral hygiene
- Antibiotic prophylaxis before dental procedures for highest-risk patients (per guidelines)
- Safe injecting practices
Outlook
Serious: in-hospital mortality is about 15–20% even with treatment.
When to see a doctor
Seek urgent care for persistent fever if you have a heart valve problem, artificial valve or inject drugs.
Sources and further reading
These sources cover this condition. They have not been checked against every statement on this page.
Related conditions
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