ENDOCARDITIS

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Definition

Endocarditis is inflammation of the inside lining of the heart chambers and heart valves (endocardium).

See also:

• Culture-negative endocarditis
• Infective endocarditis

Alternative Names

Valve infection

Causes, incidence, and risk factors

Endocarditis can involve the heart muscle, heart valves, or lining of the heart. Most people who develop endocarditis have heart disease of the valves.

Risk factors for developing endocarditis include:

• Injection drug use
• Permanent central venous access lines
• Prior valve surgery
• Recent dental surgery
• Weakened valves

Bacterial infection is the most common source of endocarditis. However, it can also be caused by fungi. In some cases, no cause can be identified.

Symptoms

• Abnormal urine color
• Chills (common)
• Excessive sweating (common)
• Fatigue
• Fever (common)
• Joint pain
• Muscle aches and pains
• Night sweats
• Nail abnormalities (splinter hemorrhages under the nails)
• Paleness
• Red, painless skin spots on the palms and soles (Janeway lesions)
• Red, painful nodes in the pads of the fingers and toes (Osler's nodes)
• Shortness of breath with activity
• Swelling of feet, legs, abdomen
• Weakness
• Weight loss

Note: Endocarditis symptoms can develop slowly (subacute) or suddenly (acute).

Signs and tests

Doctors might suspect endocarditis in people with a history of:

• Congenital heart disease
• Intravenous drug use
• Recent dental work
• Rheumatic fever

The health care provider may detect a new heart murmur, or a change in a previous heart murmur. Examination of the nails may show splinter hemorrhages.

An eye exam may show bleeding in the retina a central area of clearing. This is known as Roth's spots. There may be small, pinpoint hemorrhages (petechiae) in the conjunctiva. The fingertips may be enlarged, and the nails may appear curved. This is called clubbing.

Tests:

• Blood culture
• Complete blood count (CBC)
• Chest x-ray
• C-reactive protein (CRP)
• Echocardiogram
• ECG
• Erythrocyte sedimentation rate (ESR)
• Serology
• Transesophageal echocardiogram

Reviewer Info: D. Scott Smith, M.D., MSc, DTM&H, Chief of Infectious Disease & Geographic Medicine, Kaiser Redwood City, CA & Adjunct Assistant Professor, Stanford University. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., 09/03/2008