How serious is endocarditis?

Endocarditis is life-threatening with mortality rates of 15–30% even with treatment. Without treatment, it is almost always fatal. Early diagnosis is critical.

Can endocarditis come back?

Recurrence occurs in about 5–10% of patients. People with prosthetic valves or IV drug use are at highest risk. Lifelong dental health attention is important.

Do I need antibiotics before dental work?

Antibiotic prophylaxis is now recommended only for the highest-risk patients: those with prosthetic valves, previous endocarditis, certain congenital defects, or cardiac transplant recipients with valve problems.

CardiovascularICD-10: I33Approximately 15 cases per 100,000 people annually in the U.S.

Endocarditis

Also known as: Infective Endocarditis, Bacterial Endocarditis

Endocarditis is a serious infection of the inner lining of the heart chambers and valves, typically caused by bacteria entering the bloodstream. Without treatment, it can destroy heart valves and cause life-threatening complications including stroke and heart failure. Prompt diagnosis and aggressive antibiotic therapy are essential.

Symptoms

Persistent fever and chills

Night sweats

Fatigue and malaise

New or changing heart murmur

Aching joints and muscles

Shortness of breath

Petechiae on the skin, whites of eyes, or inside the mouth

Janeway lesions (painless red spots on palms and soles)

Unexplained weight loss

Causes

Bacteria entering the bloodstream (Staphylococcus aureus, Streptococcus viridans)
Intravenous drug use
Dental procedures causing temporary bacteremia
Infections elsewhere in the body
Poor dental hygiene

Risk Factors

Pre-existing heart valve disease or artificial valves
History of previous endocarditis
Intravenous drug use
Congenital heart defects
Implanted cardiac devices
Poor dental health

Diagnosis

Blood cultures (multiple sets) to identify the organism
Transesophageal echocardiography to visualize vegetations
Modified Duke criteria combining clinical, microbiological, and imaging findings
CT or MRI to detect embolic complications

Treatment

Prolonged IV antibiotics (4–6 weeks) tailored to the organism
Empiric antibiotic therapy while awaiting cultures
Surgical valve repair or replacement for severe valve destruction
Treatment of complications (stroke, abscess, heart failure)
Addiction treatment for IV drug use-related cases

Prevention

Maintain excellent dental hygiene and regular dental care
Antibiotic prophylaxis before certain dental procedures for high-risk patients
Avoid IV drug use
Seek prompt treatment for skin infections

When to See a Doctor

Persistent unexplained fever with risk factors for endocarditis
New heart murmur or worsening of existing one
Unexplained small spots on skin, nails, or eyes
You have an artificial heart valve and develop fever

Frequently Asked Questions

Related Conditions

Heart Failure

Cardiovascular

Heart Attack

Cardiovascular

High Blood Pressure

Cardiovascular

HIV/AIDS

Infectious

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