Endocarditis is an inflammation of the endocardium, the inner layer of the heart, including the heart valves. Learn more about endocarditic in this health video.
DAVE WEILAND: Hi. This is Dr. David Weiland. We're now going to talk about endocarditis. Endocarditis involves infection of the heart valves, 1) Aortic valve, 2) Mitral valve, and 3) the tricuspid valve; very rarely the pulmonic valve gets involved. Tricuspid valve endocarditis is more commonly seen in intravenous drug users. Various bacterial agents can infect the heart valves. It is more commonly in people with underlying heart disease. Anybody who has had previously had a heart murmur, was born with an abnormal heart valve is at risk for endocarditis. Symptoms of endocarditis are varied. They often mirror the symptoms of a viral infection with fever, generalized fatigue, loss of appetite, muscle pain, and can be very difficult to figure out. The diagnosis is often made by drawing blood. We like to see infection in the blood itself, and that's called a blood culture, which is done in any certified laboratory. If there was evidence of infection in the blood stream with a bacterial agent, then clearly we would worry about things like Staph aureus, then one often should have an echocardiogram performed. An echocardiogram takes pictures of the valves by putting a transducer up against the chest wall. If there is a high suspicion for endocarditis, the diagnosis is often made by using a transesophageal echocardiogram where the patient actually swallows the echo probe which gives us better pictures of the heart valves. Treatment of endocarditis involves a prolonged course of antibiotics often given intravenously. Because endocarditis can be so devastating in its effect on the heart valves, it is generally recommended that the patients receive antibiotics for at least 6 weeks. With infection such as staph aureus, this would involve 6 weeks of intravenous antibiotics. Because that is such a prolonged course, oftentimes the antibiotics are given at home, so the patient will leave the hospital with an IV place and either have a nurse of their family members help administer the antibiotics once or twice a day at home. Prevention of endocarditis: This is a controversial area. Up until the last year, it was recommended that any patient with a heart murmur receive prophylactic antibiotics before any dental work. Clearly, dental work will induce and transmit bacteria into the blood stream through the gums, and the recommendations have now changed so that only very high-risk patients, patients with congenital heart disease of previous valve replacement receive antibiotics before dental work. However, keeping your teeth clean, keeping your gums free of infection can prevent endocarditis from occurring. In addition, infections in any part of the body especially bacterial infections need to be under the care of a physician and treated aggressively, because if the infections do get in the blood stream they can eventually spread to the heart valves. How to take action: If a patient has endocarditis, they need to be under the care of an internist and possibly the infection disease specialist as well as a cardiologist. We recommend ongoing surveillance in our patients with endocarditis to make sure that we have full treated the infection. This would involve rechecking blood cultures one to two weeks after the antibiotics have been discontinued as well as repeating the echocardiographic studies on a regular basis.
