Endocarditis is inflammation of your heart’s inner lining, called the endocardium.

It is usually caused by bacteria.

When the inflammation is caused by infection, the condition is called infective endocarditis.

Endocarditis is uncommon in people with healthy hearts.

The symptoms of endocarditis aren’t always severe, and they may develop slowly over time.

In the early stages of endocarditis, the symptoms are similar to many other illnesses.

This is why many cases go undiagnosed.

Many of the symptoms are similar to cases of the flu or other infections, such as pneumonia.

Some people experience severe symptoms that appear suddenly: These symptoms may be due to inflammation or the associated damage it causes.

Common symptoms of endocarditis include:

heart murmur, which is an abnormal heart sound of turbulent blood flow through the heart

pale skin

fever or chills

night sweats

muscle or joint pain

nausea or decreased appetite

a full feeling in the upper left part of your abdomen

unintentional weight loss

swollen feet, legs, or abdomen

cough or shortness of breath

Less common symptoms of endocarditis include:

blood in the urine

weight loss

an enlarged spleen, which may be tender to touch

Changes in the skin may also occur, including:

tender red or purple spots below the skin of fingers or toes

tiny red or purple spots from blood cells that leaked out of

ruptured capillary vessels, which usually appear on the whites of the eyes, inside the cheeks, on the roof of the mouth, or on the chest

The signs and symptoms of infectious endocarditis vary greatly from person to person.

Symptoms can change over time, and they depend on the cause of infection, heart health, and how long the infection has been present.

The presentation is variable with a fever, fatigue, symptoms related to infection extending into the conduction system, heart failure, and arrhythmias.

The main cause of endocarditis is an overgrowth of bacteria.

In the case of infective endocarditis, bacteria travel through the bloodstream and into the heart, where they multiply and cause inflammation.

Endocarditis can also be caused by fungi or other germs.

Bacteria can enter the bloodstream:

brushing your teeth

having poor oral hygiene or gum disease

having a dental procedure that cuts your gums

contracting a sexually transmitted disease

using a contaminated needle

through an indwelling urinary catheter or intravenouscatheter

The following tests may also be done:

Blood culturesTransthoracic echocardiogram

Transesophageal echocardiogram/transesophageal echocardiogram.


Chest X-ray

Treatment; intravenous antibiotic therapy.

Surgery for ;damaged heart valves

Transthoracic echocardiography should be performed at all cases of suspected endocarditis.

Transesophageal  echocardiography  is important if transthoracic Echochoreography is negative and endocarditis is still suspected.

Intraoperative transesophageal  echocardiography  is routinely performed at the time of surgery for infectious endocarditis.

Cardiac CT has a similar accurate diagnostic capability for detecting the presence of  valvular vegetations compared with transesophageal echocardiography, althoughsmall vegetations were more commonly missed by CT.

Cardiac CT improve the accuracy in the detection of perry valvular abscesses and pseudo aneurysms anything valuable tool and surgical planning.

PET scanning is based on the uptake of F-fluorodeoxyglucose by cells such as leukocytes and monocytes, and can reduce the diagnosis of possible infectious endocarditis cases.


Optimal antimicrobial therapy involves four weeks or longer use of bactericidal agents in an attempt to eradicate infections.

Initial antimicrobial therapy is often empirical based on patient and epidemiologic factors.

Treatment of streptococcal infections endocarditis due to viridans group streptococci is dependent on penicillin minimum inhibitory concentration data.

In highly susceptible strains of streptococci monotherapy with parenteral penicillin or ceftriaxone has been highly effective.

Vancomycin is an acceptable alternative.

The addition of gentamicin for the initial two weeks of treatment is reasonable in streptococci not highly susceptible to penicillin and in patients with prosthetic valves or prosthetic material.

Antibiotic therapy for staphylococcal IE, depends on whether the staphylococcus are coagulase positive or coagulase negative and the presence or absence of prosthetic valves or prosthetic material.

Native valve endocarditis due to methicillin sensitive Staph aureus is typically treated with beta-lactamase such as nafcillin re cefazolin.

Vancomycin is the treatment of choice for native valve infectious endocarditis due to MRSA: Daptomycin is an acceptable alternative,

Aminoglycosides and rifampin are not recommended for native valve endocarditis due to MRSA or SA but it is suggested,because of the presence of a biofilm formation on prosthetic devices, that these agents be added to beta lactam therapy for the initial two weeks for prosthetic valve endocarditis.

For endocarditis due to enterococci combinations of penicillin and an aminoglycoside are suggested.

Patients with prosthetic valve endocarditis receiving anticoagulation have a significantly higher mortality than those with native valve endocarditis in most patients with prosthetic valve infectious endocarditis die of CNS complications: current recommendations is to discontinue anticoagulants in patients with infectious endocarditis and mechanical valve who also have CNS embolic events for at least 2 weeks.

Anticoagulation management patients with infectious endocarditis who have not had an intracerebral event remains controversial.

Guidelines recommend that anti-platelet agents not be routinely initiated in patients with infectious endocarditis, although continuation of long-term anti-platelet agents and patients with low bleeding risk is reasonable.

Indications for surgery involve the presence of valve dysfunction causing heart failure, persistent bacteremia, involvement with fungi or drug resistant organisms.

Early surgery is recommended for patients with hemodynamic compromise, uncontrolled infection with persistent fever or perivalvular extension of infection, and prevention of embolism.

Surgery is delayed for at least four weeks in patients with major stroke or intracranial hemorrhage.



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