Endocarditis risk factors: who is more likely to get it

What endocarditis is

Endocarditis is a rare but life-threatening inflammation of the lining inside your heart's chambers and valves (the endocardium). It is usually caused by germs that get into your bloodstream and travel to your heart, where they can attach to the lining or get trapped in the valves and start to grow. If not treated quickly, the infection can damage the heart and lead to serious health problems (MedlinePlus).

Endocarditis is one of three types of heart inflammation. The other two are myocarditis (the heart muscle) and pericarditis (the tissue around the heart) (NHLBI).

What causes it

Bacteria are the most common cause of endocarditis. Bacteria and blood cells form clumps, most often on the heart valves. In many advanced countries, Staphylococcus aureus (staph) is the most common type. Bacteria can enter the blood in many ways, including during a medical or dental procedure or through drugs injected into the veins by needle (NHLBI).

Many bacteria normally live in your mouth, on your skin, or in other parts of the body. They can get into your bloodstream from injuries such as cuts or scrapes, and dental work and certain surgeries can also let small amounts of bacteria in. In some cases, fungal infections such as yeast cause endocarditis, generally in people whose immune systems are weakened, including people who have HIV (MedlinePlus).

Autoimmune diseases, such as rheumatoid arthritis and lupus, can damage the heart valves, which can lead to endocarditis (NHLBI).

Who is more likely to get it

In general, endocarditis is rare. If you are healthy, your immune system usually destroys germs in your bloodstream before they can cause harm (MedlinePlus). MedlinePlus says your chance may be higher than most people's if you (MedlinePlus):

• Have certain heart conditions: heart valve disease, certain congenital heart defects, a pacemaker or an implantable defibrillator, or a heart valve replacement. Damaged or abnormal heart tissue and devices in the heart can trap germs more easily than healthy heart tissue (MedlinePlus).
• Are older: age-related changes to the heart valves, such as mitral valve prolapse or calcium deposits in the aortic valve, create places for germs to attach (MedlinePlus).
• Inject illegal drugs: unclean needles may carry bacteria into the bloodstream (MedlinePlus).
• Have a condition that weakens your immune system (MedlinePlus).
• Do not take care of your teeth and gums: poor dental health makes it easier for germs to get into your bloodstream through your gums and mouth (MedlinePlus).
• Have a long-term central venous line, a tube that stays in a large vein for weeks or months for medical treatment (MedlinePlus).
• Have already had endocarditis: it can damage heart tissue, which increases the risk of getting it again (MedlinePlus).

The NHLBI adds that older adults are more at risk for endocarditis caused by bacteria, that endocarditis occurs twice as often in men as in women, and that people who have structural or congenital heart defects, such as problems with the heart valves, may be at higher risk for infections that can cause endocarditis (NHLBI). For heart inflammation in general, the NHLBI also lists injecting recreational drugs into the veins, diabetes (which can make infections more likely), skin disorders such as burns or chronic infections, poor dental health, and procedures such as implanting a pacemaker or defibrillator, which carry a risk of infection (NHLBI).

Symptoms

Endocarditis symptoms may be severe or very mild, may start suddenly or slowly, and can vary from person to person (MedlinePlus). Possible symptoms include fever and chills, a new or worsening heart murmur, chest pain, cough, muscle, joint, and back pain, night sweats, shortness of breath, and skin changes such as broken blood vessels, painful red or purple bumps, or painless flat red spots on the palms or soles (MedlinePlus). The NHLBI lists fever and chills and a new or worsening heart murmur, or abnormal heart sounds, as common endocarditis symptoms (NHLBI).

Problems it can lead to

Germs in the heart can clump together with blood cells. These clumps can break off and travel through the bloodstream, where they may block blood flow, spread infection, or damage organs, including the brain, lungs, kidneys, and spleen (MedlinePlus). Endocarditis may sometimes lead to sepsis, a medical emergency, and can cause heart valve damage, heart failure, and arrhythmia (a problem with the rate or rhythm of the heartbeat) (MedlinePlus).

Lowering the risk

If you have a higher chance of endocarditis than most people, MedlinePlus says you can reduce your risk if you take good care of your teeth and gums every day, have dental exams and cleaning every 6 months, make heart-healthy habits part of your daily life to help prevent heart disease, and call your provider right away if you have symptoms that could be endocarditis (MedlinePlus). The NHLBI also lists avoiding recreational intravenous drugs and washing your hands and skin regularly and cuts or scrapes right away (NHLBI).

People with the highest risk for bacterial endocarditis need antibiotics before dental visits or certain medical or surgical procedures. Ask your provider if you are in the highest risk group, and if so, let all your providers know (MedlinePlus).

Diagnosis and treatment

A provider will ask about your medical history, do a physical exam, and likely order tests such as blood tests, chest x-rays, and heart tests. Treatment should start quickly and may include antibiotics (usually started through an IV line in the hospital) or antifungal medicine, and sometimes heart surgery to repair or replace damaged valves. Treatment may last weeks (MedlinePlus).

NHLBI says good skin and dental hygiene can help protect you from infections that cause endocarditis, which can damage the heart valves, and MedlinePlus lists endocarditis among the conditions that make heart valve disease more likely. See aortic stenosis risk factors (NHLBI) (MedlinePlus).

Common questions

What is the most common cause of endocarditis?

Bacteria are the most common cause. In many advanced countries, Staphylococcus aureus is the most common type (NHLBI).

Can you get endocarditis from dental work?

Dental work can allow small amounts of bacteria into the bloodstream (MedlinePlus). People with the highest risk need antibiotics before dental visits; ask your provider whether that includes you (MedlinePlus).

Can you get endocarditis more than once?

Yes. Endocarditis can damage heart tissue, which increases the risk of getting it again (MedlinePlus).