Bacterial Endocarditis

Signs and Symptoms

Bacterial endocarditis is an infection of either the heart valves or of the inner surface, called the endocardium, of the heart. Bacteria in the mouth, intestinal tract or urinary tract travel to the heart via the bloodstream but usually don't cause a problem in normal hearts. However, hearts that have defects, often even if the defects have been repaired, are vulnerable to infection. Once infection occurs, the bacteria continue to grow and may seriously damage the heart.

Bacterial endocarditis is most likely to occur in patients who have:

• Aortic Valve Lesions
• Patent Ductus Arteriosus
• Tetralogy of Fallot
• Ventricular Septal Defect
• Aortic Coarctation
• Mitral Valve Prolapse
• Transposition of the Great Arteries

It is unlikely to occur in patients who have a completely repaired pulmonary valve stenosis, atrial septal defect, ventricular septal defect or patent ductus arteriosus.

The usual signs of bacterial endocarditis are prolonged fever for two to three days in a person with congenital heart disease that occurs after a procedure in the mouth, intestinal tract or urinary tract. However, the infection may occur without a previous procedure. Symptoms may include:

• Poor appetite
• Fatigue
• Joint pain
• Rash
• Weight loss

Diagnosis

A blood test is the major test for bacterial endocarditis. Three to five blood samples may be taken in a 24-hour period to determine the presence of the bacteria. A urine sample also may indicate the presence of infection but is not adequate by itself for the diagnosis. An echocardiogram may detect an abnormality, such as a mass on a heart valve or on the heart wall surface, called a vegetation.

Treatment

Bacterial endocarditis usually can be prevented by taking antibiotics immediately before and after procedures in which bacteria may be released into the bloodstream, such as:

• Dental cleaning
• Tonsillectomy and adenoidectomy
• Bronchoscopy
• Some surgeries in the respiratory passageways, or the gastrointestinal or urinary tracts
• Gallbladder or prostate surgery

In addition, people at risk for bacterial endocarditis are encouraged to practice good oral hygiene.

Once endocarditis is diagnosed, treatment usually consists of intravenous antibiotics. Recovery may take four to six weeks and there is a risk of permanent heart damage.