Endocarditis – Diagnosis and Treatment
Diagnosis
Medical and Laboratory Evaluations
Doctors begin by looking at a patient’s symptoms and health history, asking about recent illnesses, heart conditions, or procedures.
Some symptoms that raise suspicion are fever, chills, night sweats, heart murmur, new or worsening shortness of breath, chest pain, cough, back pain, joint pain, palpitations, fatigue, and weight loss.
A heart murmur or signs of heart failure may be found during a physical exam.
To confirm the diagnosis, doctors use several tests together:
| Test or Method | What It Checks For | How It Helps in Diagnosis |
|---|---|---|
| Blood Culture | Bacteria in the bloodstream (bacteremia) | Identifies the cause, guides antibiotics |
| Complete Blood Count (CBC) | Infection, anemia, and other signs of illness | Shows high white cells, anemia |
| Echocardiogram (Echo) | Heart valves, chamber structure, vegetation | Detects valve damage and growths |
| Transesophageal Echocardiogram | Detailed images of the heart’s valves and chambers | Finds smaller vegetations |
| Electrocardiogram (ECG/EKG) | Heart rhythm and electrical activity | Checks for changes due to infection |
| Chest X-ray | Heart and lung condition | Checks for enlargement or spread |
| CT/MRI Scans | Organs such as the brain, lungs, or other body areas | Locates infection elsewhere |
| Other Blood Tests | Inflammatory markers (like C-reactive protein) | Looks for signs of systemic illness |
Physicians also use clinical standards called the Duke criteria.
These include both major findings (like positive blood cultures for classic bacteria such as staphylococci, streptococci, and enterococci, or clear evidence of heart valve damage) and minor findings (such as fever, vascular or immune markers like Roth spots, Osler nodes, and Janeway lesions).
Additional Diagnostic Details
Doctors rely on a mix of symptoms, medical findings, imaging, and laboratory results for making the diagnosis. Certain groups have a higher risk, including people with weakened heart valves, prosthetic (artificial) devices, or previous endocarditis.
Negative blood cultures can sometimes occur, especially with prior antibiotic use or if rare bacteria or fungi cause the infection. Doctors may order more detailed tests or repeated cultures in these cases.
Advanced scans, like a transesophageal echocardiogram, provide a closer look at the heart and help spot small vegetations or abscesses.
If doctors suspect noninfective endocarditis or rare causes like fungal infection, they use specialized tests and conduct a thorough evaluation. They pay close attention to symptoms and changes in condition throughout the diagnosis process.
Treatment
Medicines for Endocarditis
Doctors often start treatment using high-dose antibiotics to fight bacteria causing the infection. They usually give these medicines through an IV (a tube in the vein), and patients may stay in the hospital for a week or more.
Health care providers monitor how well the antibiotics are working and watch for side effects.
Once a person’s fever and serious symptoms improve, doctors may have them finish antibiotic therapy at home or with clinic visits. Most people need antibiotics for several weeks to make sure the infection is gone.
When fungi cause endocarditis, doctors prescribe antifungal drugs. Some people might need to take antifungal tablets for a long time to stop the illness from coming back.
A typical antibiotic treatment course may look like:
| Medication Type | Used For | Duration |
|---|---|---|
| Antibiotics (IV) | Bacterial endocarditis | 4-6 weeks |
| Antifungal medicines | Fungal endocarditis | Lifelong for some cases |
Procedures and Heart Valve Operations
Sometimes, medicine alone cannot fix the damage. If a heart valve is badly hurt or the infection will not go away, doctors might suggest surgery. Surgeons can remove infected tissue, fix leaks, or replace the valve with a new one.
There are two main options for heart valve replacement:
- Mechanical valves (made from metal or plastic).
- Biologic tissue valves (made from cow, pig, or human tissue),
Doctors recommend surgery if problems develop, like heart failure, stroke, septic emboli (blood clots spreading germs), or a risk of sepsis (widespread infection). In some cases, heart surgery can prevent further issues like stroke or pulmonary embolism.
Treatment plans depend on the patient’s health and how well they respond to the first treatment.
Getting Ready for Your Visit
Steps You Can Take Beforehand
Being prepared for a medical appointment can help patients get the best care, especially when it comes to concerns about heart problems like endocarditis. Here are some useful tips:
- List Out Symptoms: Write down any symptoms you notice, such as chest pain, shortness of breath, fever, or swelling. Note how long they have lasted and if any have happened before.
- Track Medical History: Be ready to share details about past health issues. This can include anything from congenital heart disease or rheumatic fever to procedures such as hemodialysis or having a pacemaker or artificial heart valve.
- Record All Medications: Make a detailed list of any medicines and supplements being used, including their doses. This is important if the person uses preventive antibiotics for dental procedures or takes other drugs for conditions such as mitral valve prolapse.
- Consider Bringing Support: A trusted family member or friend can help remember key information and provide support during the appointment.
- Write Down Questions: Before the appointment, prepare clear questions. Examples include:
- What could be causing these symptoms?
- What tests or screenings are needed?
- Do you recommend any special preparations for procedures?
- Are antibiotics needed before dental care?
- What are the possible treatment side effects?
- Does my history increase my risk of endocarditis?
- Are there long-term risks or chances of recurrence?
- How can other health issues be managed together with this condition?
Tip: Keeping a small binder or notebook with all medical information makes future visits easier.
| Info to Prepare | Why It Helps |
|---|---|
| Symptoms with timing | Identifies patterns |
| Full medical and surgical history | Assesses risk factors |
| Full medication and supplement list | Avoids drug interactions |
| Previous procedures (dental, cardiac) | Determines if preventive steps are needed |
What the Healthcare Provider Will Discuss
During the visit, the healthcare provider will want to learn as much as possible to decide on the right care plan. The provider may ask questions such as:
- What symptoms do you have? When did they start? Have they changed over time?
- Have you had any recent infections or procedures, like dental work, surgery, or use of an intravenous line or catheter?
- Do you or your family members have a history of heart conditions (like rheumatic heart disease, implanted defibrillator, or congenital heart defects)?
- Have you experienced unexplained weight loss, breathing problems, or fevers?
- Are there risk factors, such as intravenous drug use or the presence of an artificial heart valve or pacemaker?
- Do your close relatives have a history of heart disease or specific heart problems?
- Have you ever taken antibiotics before dental appointments or had past episodes of endocarditis?
The provider will examine the mouth, teeth, and gums for signs of infection. The provider will also review dental hygiene and recent dental visits to assess potential causes and prevention steps.
