Infective endocarditis

Also called bacterial endocarditis

Infective endocarditis is a rare but serious condition that people with some heart conditions are at risk of developing.

Key points about infective endocarditis

  1. Infective endocarditis is an infection caused by bacteria that enter your bloodstream and settle in your heart lining, heart valve or blood vessel.
  2. It is a very rare but serious condition that requires hospital-based treatment, and a long course of antibiotic medicine treatment.
  3. People with some heart conditions, such as artificial heart valves, have a greater risk of developing it.
  4. You may need to have antibiotic medicines before some dental and surgical procedures that increase the chance of bacteria getting into your bloodstream.
  5. You can reduce your chance of bacteria getting into your bloodstream by taking good care of your skin and teeth.

Who is at risk of infective endocarditis?

Infective endocarditis can affect anyone, but people who have specific heart problems are at increased risk, eg, if you have:

  • previously been diagnosed with rheumatic heart disease
  • a condition that affects your heart valves
  • have had a replacement heart valve within 6 months
  • previously been diagnosed with infective endocarditis
  • some types of heart condition from birth (congenital heart disease), even if you have had an operation to correct the problem
  • non-medical intravenous drug use.

What are the symptoms of infective endocarditis?

Infective endocarditis is a serious infection that requires immediate medical attention. You should contact your GP as soon as possible if you notice any of the following symptoms, particularly if they occur together as a flu-like illness:

  • a high temperature (fever) of 38°C or above (which may fluctuate)
  • sweats or chills, especially at night
  • breathlessness, especially during physical activity
  • weight loss
  • tiredness (fatigue)
  • body aches, muscle, joint or back pain (unrelated to recent physical activity)
  • swelling of your feet, legs and abdomen.

These symptoms are more likely to be caused by a less serious type of infection. However, if you have one of the conditions listed above, your doctor will be even more likely to investigate. Make sure you tell them about any recent dental treatment you have had.

How is infective endocarditis diagnosed?

In response to symptoms you present, and the clinical findings, you may have the following procedures: 

  • a blood test to look for bacteria in your bloodstream
  • an echocardiogram
  • an ultrasound examination
  • admission to hospital for appropriate therapy.

How can I reduce my risk of infective endocarditis?

You can reduce your risk of infective endocarditis by taking steps to lessen the chance of bacteria getting into your bloodstream. This includes looking after your teeth and gums and taking care of your skin. Lack of appropriate oral and skin care can allow bacteria to enter your bloodstream. 

Looking after your teeth and gums

  • Clean your teeth regularly and carefully, using fluoride toothpaste.
  • Have regular dental check-ups.
  • Avoid sugary snacks and drinks.
  • Do not smoke. 
  • Limit the amount of alcohol you drink.

Looking after your skin

  • Regularly wash your skin with soap and water.
  • Clean any cuts or grazes carefully to prevent them becoming infected.
  • Avoid non-medical procedures that involve piercing your skin, including body piercing or tattooing.

What is antibiotic prophylaxis?

Some procedures may increase the chances of bacteria entering your bloodstream, such as some dental procedures, removal of your tonsils or adenoids. Other procedures that put you at risk may involve your lungs, kidneys, gut or skin.

It is important to tell your dentist, GP or anyone who is treating you if you have any of the conditions that put you at increased risk of infective endocarditis. They will assess whether any extra precautions are needed, such as a course of antibiotics before the procedure. This is called antibiotic prophylaxis and is only needed for some procedures. Dental procedures such as taking x-rays or placement of braces do not require antibiotic prophylaxis. 

References

  1. Guideline for prevention of infective endocarditis associated with dental and other medical interventions National Heart Foundation, NZ, 2008
  2. Infective endocarditis prophylaxis 3D Community HealthPathways, NZ

Reviewed by

After 45 years of GP experience, and 8 years as an examiner and practice assessor, Dr Bryan Frost has completed a Diploma in Editing and is pursuing a new career. He also has a Diploma in Health Administration, with honours in management, and has also completed a paper in Health Care Law.
Credits: Health Navigator Editorial Team. Reviewed By: Dr Bryan Frost, FRNZCGP, Morrinsville Last reviewed: 16 Jun 2021