Endocarditis

A bacterial infection of the inside lining of the heart (see Diagram — Anatomy of the Heart).  It comes in two variations, “Acute” (sudden), and “Sub-Acute” (low-grade).

Acute Endocarditis is life-threatening.  It interferes with the heart’s ability to pump blood.  Patients have high fevers, drenching sweats, are short of breath.  Sub-Acute Endocarditis is serious, but less of a medical emergency.  Symptoms include fever, night sweats, weight loss, fatigue, achiness.

Risks for endocarditis include injecting drugs (especially injecting IV); diseases of heart valves, or artificial metal valves; significant tooth and gum disease; and patients with catheters in their veins for chemotherapy or other medications (not urine catheters).

We suspect Endocarditis in patients at risk who have fevers.ย  We also listen with a stethoscope for heart murmurs, and do blood tests for suggestion of bacterial infection (high white blood cells, high Sed Rate or CRP, or anemia).ย  If we’re suspicious, we might order an echocardiogram.ย  If we’re really suspicious, we order a lot of blood cultures, since the bacteria may be hard to find.ย  If we worry about Acute Endocarditis, we send them right to an ER.

Treatment may involve 6 to 8 weeks of IV antibiotics, depending on the germ (see Germs: Differences Among Them).

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