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Illustration of anatomical heart against blue background to represent the heart after endocarditis treatment

Endocarditis Treatment: When It's Needed and How It Works

Written on July 28, 2023 by Lori Mulligan, MPH. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

Table of contents

What Is Endocarditis?

Endocarditis is a life-threatening inflammation of the inner lining of the heart's chambers and valves. This lining is called the endocardium.

Endocarditis is usually caused by an infection. Bacteria (including certain sexually transmitted infections), fungi, or other germs get into the bloodstream and attach to damaged areas in the heart. Factors that make you more likely to get endocarditis include artificial heart valves, damaged heart valves, or other heart defects.

Without quick treatment, endocarditis can damage or destroy the heart valves. Treatments for endocarditis include medications and surgery.[1]

What Causes Endocarditis?

Bacteria that cause infective endocarditis reach the heart through the bloodstream.

Normally, heart valves are highly resistant to the attachment of bacteria and resulting infection. Damage to the heart valves and inner lining of the heart is the main risk factor for infective endocarditis because it leaves the tissue susceptible to bacterial overgrowth.

As the microorganisms quickly move past the damaged valve lining, those strains that can most strongly adhere to the surface are bacteria that have the best chance of producing infective endocarditis.

Clumps of bacteria and cells called vegetations form on the heart valves, affecting proper functioning of the heart. If left untreated, this vegetation may cause the valve to leak or may result in an abscess next to the valve or in the heart muscles. This can lead to tissue damage and blockage of the normal electrical conduction pathways. In addition, the vegetation may break loose and cause damage to the brain (stroke), kidneys, or lungs.

Risk factors that contribute to the onset of endocarditis include:

  • Intravenous drug use with a needle contaminated with bacteria or fungi
  • Presence of an artificial (prosthetic) heart valve or other valve repair material
  • Presence of a cardiac pacemaker
  • Previous infective endocarditis
  • Mitral valve prolapse with valve leakage
  • An aortic valve with only 2 (instead of the normal 3 valve leaflets). This condition, called a bicuspid aortic valve, is present in about 1% of people.
  • Narrowing of the aortic valve due to age-related calcification
  • Other abnormal valves caused by rheumatic fever and degenerative conditions
  • Congenital heart disease, especially if repaired with artificial material
  • Immunosuppressive medication
  • Dental procedures (in patients with other risk factors)
  • Infections elsewhere in the body and chronic indwelling catheters (such as for chemotherapy)

Approximately 80% of endocarditis cases are caused by the bacteria streptococci and staphylococci. The third most common bacteria causing this disease is enterococci, which, like staphylococci, is commonly associated with healthcare-associated endocarditis. While very rare, infections due to gram-negative and fungal pathogens are often acquired in healthcare settings.[2]

Some sexually transmitted infections, such as gonorrhea, can result in endocarditis if the infection is not treated promptly.

Private STD consultations

What Are the Symptoms of Endocarditis?

Symptoms of endocarditis may develop slowly or suddenly.

Fever, chills, and sweating are frequent symptoms. These sometimes can be present for days before any other symptoms appear. They may also come and go, or be more noticeable at nighttime.

You may also experience fatigue, weakness, weight loss, loss of appetite, and aches and pains in the muscles or joints.

Other signs of endocarditis can include[3]:

  • Small areas of bleeding under the nails (splinter hemorrhages)
  • Red, painless skin spots on the palms and soles (Janeway lesions)
  • Red, painful nodes in the pads of the fingers and toes (Osler nodes)
  • Shortness of breath with activity
  • Swelling of the feet, legs, or abdomen

How Is Endocarditis Diagnosed?

Endocarditis should be suspected in any patient with unexplained fevers, night sweats, or signs of systemic illness, particularly if any of the following risk factors are present:

  • A prosthetic heart valve
  • Structural or congenital heart disease
  • Intravenous drug use, and a recent history of invasive procedures (e.g., wound care, hemodialysis)

The diagnosis of endocarditis requires multiple clinical, laboratory, and imaging findings. Overdiagnosis and underdiagnosis of endocarditis can be problematic; a missed diagnosis could prove fatal, whereas overdiagnosis can result in weeks of unnecessary antibiotic treatment.

The widely accepted Duke criteria use a set of major and minor clinical and pathologic criteria to classify endocarditis as definite, possible, or rejected. Direct evidence of endocarditis can be obtained from histologic specimens collected during surgery or autopsy, or from a combination of two major clinical criteria, one major and three minor criteria, or five minor criteria.

Possible endocarditis is defined as the presence of one major and one or two minor criteria, or three minor criteria.[4]

How Do You Treat Endocarditis?

Endocarditis can be life-limiting. Once you get it, you’ll need quick treatment to prevent damage to your heart valves and more serious complications.

After taking your blood cultures, your healthcare provider will start you on intravenous (IV) antibiotic therapy. They’ll use a broad-spectrum antibiotic to cover as many suspected bacterial species as possible. As soon as they know which specific type of organism you have, they’ll adjust your antibiotics to target it. Usually, you’ll receive IV antibiotics for as long as six weeks to cure your infection.

Your provider will monitor your symptoms throughout your therapy to see if your treatment is effective. They’ll also repeat your blood cultures.

If endocarditis damages your heart valve and any other part of your heart, you may need surgery to fix your heart valve and improve your heart function.

After you complete your treatment, your provider will determine the sources of bacteria in your blood (for example, dental infections) and treat them. In the future, you should take preventive antibiotics according to national guidelines.

What Medications/Treatments Are Used?

Antibiotics treat bacterial endocarditis. For other types of endocarditis, you may need blood thinners or antifungal medicines. Medicines can have side effects, but this treatment is necessary to protect your life. Some people feel better within a few days of starting treatment. For others, it can take longer.[5]

How Can Everlywell Help?

For online STD treatment to help prevent endocarditis, Everlywell offers a telehealth option that lets you quickly connect with a clinician to discuss your concerns.

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  1. Endocarditis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/endocarditis/symptoms-causes/syc-20352576. Accessed on July 18, 2023.
  2. Infective Endocarditis. National Organization for Rare Disorders. https://rarediseases.org/rare-diseases/endocarditis-infective. Accessed on July 18, 2023.
  3. Endocarditis. Penn Medicine. https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/endocarditis. Accessed on July 18, 2023.
  4. Pierce D, Calkins C., Thornton K. Infectious Endocarditis: Diagnosis and Treatment. Am Fam Physician. 2012;85(10):981-986.
  5. Endocarditis. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/16957-endocarditis#management-and-treatment. Accessed on July 18, 2023.
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