Infective Endocarditis Symptoms, Causes and Diagnosis

Jun 03, 2019

Endocarditis is an infection of the inner lining (endocardium) of the wall of the heart valves and chambers. Also known as infective endocarditis (IE), bacterial endocarditis (BE), infectious endocarditis, and fungal endocarditis, it is a potentially fatal infection that is caused due to the pathogens entering the blood and traveling to the heart. IE occurs if any form of bacteria, fungi or germs enter the bloodstream and stick to the walls of the heart. This, in turn, causes damage to the heart and can sometimes be fatal. Depending on the types of germ causing it, endocarditis may develop very quickly (acute infective endocarditis) or slowly (subacute infective endocarditis).

Infective Endocarditis Symptoms

Infective endocarditis symptoms may vary from person to person depending on a number of factors. In fact, the same person may see different signs and symptoms that may vary over time. Besides, symptoms also vary depending on underlying heart problems, types of germ causing the infection and the type of endocarditis one has. Some of the most common symptoms of endocarditis are-
  • chills
  • shortness of breath during physical activity
  • a cough
  • a high fever of 100.4 F (38 C) or above
  • frequent headaches
  • night sweats
  • fatigue
  • muscle and joint pain
  • other flu-like symptoms
  • heart murmurs- heart makes a whooshing or swishing noise between beats
  • blood in urine
  • swollen feet, legs, and abdomen
  • nausea and vomiting,
  • decrease in appetite
  • inexplicable weight loss.
  • spots under the nails
Besides this, there may be some other symptoms as well. These include-
  • a spotty red rash on the skin also called petechiae
  • painful red spots on the palms and soles
  • mental confusion
  • narrow red-brown lines of blood running under the nails
  • painful raised lumps on toes and fingers
  • pale skin
  • enlarged spleen

Infective Endocarditis Causes

The endocardium is the thin membrane that forms the lining of heart chambers & the surface of the heart valves. The main cause behind endocarditis is a germ (usually bacteria) in the bloodstream that multiples and spreads across the endocardium. This leads to the endocardium becoming inflamed which, in turn, causes damage to the heart valves. The heart is usually among one of the most well-protected organs of the body. Usually, the heart is not affected by any bacteria passing by. However, when there is any damage to the heart valves or if there is a prosthetic valve (an artificial valve), it becomes easier for the bacteria to bypass the normal immune response to infection. The risk of developing IE also increases if one has any congenital heart disease or suffers from hypertrophic cardiomyopathy. At the site of infection, small clumps of bacteria may develop that act in a similar manner as blood clots, blocking the blood supply to other organs. This may result in organ failure or stroke. The bacteria may reach the heart through many sources like-
  • everyday oral activities like brushing, eating, especially not maintaining good oral health
  • a pre-existing infection like skin sores and gum diseases
  • medical condition like inflammatory bowel disease
  • central venous catheter
  • needles used for body piercings and tattoos
  • intravenous (IV) drug use for people using heroin or cocaine
  • dental procedures that mostly cut through the gums
  • other surgical procedures including tests to examine the digestive tract and procedures that affect breathing and the urinary tract
  • sexually transmitted infections like chlamydia and gonorrhoea that make it easier for the bacteria to enter the body

Infective Endocarditis Diagnosis

On the basis of one's medical history and symptoms, the doctor may suspect endocarditis. The diagnosis of endocarditis is based on a number of factors rather than one positive test result or symptom. Before being sure and making a positive diagnosis, the doctor advises a number of tests. The doctor would advise a patient on the following tests-

Blood test

If the doctor suspects the patient has the disease, he would order a blood culture test to confirm the presence of bacteria. Other blood tests also give more insight into the symptoms, like anaemia.

Transthoracic echocardiogram

A transthoracic echocardiogram is a non-radiating imaging test that views the heart and its valves from a wand-like device (transducer). This involves the use of ultrasound waves to create an image of the heart by placing an imaging probe on the front of your chest. This assists in the identification of signs or damage of abnormal movements of the heart.

Transesophageal echocardiogram

To observe the heart valves more closely, the doctor may suggest a transesophageal echocardiogram. It is an imaging test that views the heart with the help of a transducer attached to the end of a tube. The tube is passed from the mouth to the oesophagus and presents better pictures of the heart.


The electrocardiogram, ECG or EKG, helps to get a better view of the heart's electrical activity and detects an abnormal heart rhythm or rate. The technician attaches a few soft electrodes to the skin which are attached to electrical leads which is, in turn, attached to the EKG machine.

Chest X-ray

Certain lung problems may also have symptoms similar to endocarditis. A chest X-ray would give a clearer view of the condition of the heart and lungs. Also, the doctor will be able to analyze if the endocarditis has caused any complication in the lungs or has enlargened the heart.

CT Scan or MRI

A CT scan or MRI scan determines whether the infection has spread to other areas of the brain, chest and other body parts.

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