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What Causes Endocarditis?​

Infective endocarditis (IE) occurs if bacteria, fungi, or other germs invade your bloodstream and attach to abnormal areas of your heart. Certain factors increase the risk of this happening.

A common underlying factor in IE is a structural heart defect, especially faulty heart valves. Usually your immune system will kill germs in your bloodstream. However, if your heart has a rough lining or abnormal valves, the invading germs can attach and multiply in the heart.

Other factors also can play a role in causing IE. Common activities, such as brushing your teeth or having certain dental procedures, can allow bacteria to enter your bloodstream. This is even more likely to happen if your teeth and gums are in poor condition.

Having a catheter or another medical device inserted through your skin, especially for long periods, also can allow bacteria to enter your bloodstream. People who use intravenous (IV) drugs also are at risk for IE because of the germs on needles and syringes.

Bacteria also may spread to the blood and heart from infections in other parts of the body, such as the gut, skin, or genitals.

Endocarditis Complications

As the bacteria or other germs multiply in your heart, they form clumps with other cells and matter found in the blood. These clumps are called vegetations.

As IE worsens, pieces of the vegetations can break off and travel to almost any other organ or tissue in the body. There, the pieces can block blood flow or cause a new infection. As a result, IE can cause a range of complications.

Heart Complications

Heart problems are the most common complication of IE. They occur in one-third of all people who have the infection. These problems may include a new heart murmur, heart failure, heart valve damage, heart block, or, rarely, a heart attack​.

Central Nervous System Complications

These complications occur in as many as 20 to 40 percent of people who have IE. Central nervous system complications most often occur when bits of the vegetation, called emboli, break away and lodge in the brain.

The emboli can cause local infections called brain abscesses. Or, they can cause a more widespread brain infection called meningitis.

Emboli also can cause strokes or seizures. This happens if they block blood vessels or affect the brain's electrical signals. These complications can cause long-term damage to the brain and may even be fatal.

Complications in Other Organs

IE also can affect other organs in the body, such as lungs, kidneys, and spleen.

Lungs. The lungs are especially at risk when IE affects the right side of the heart. This is call right-sided infective endocarditis.

A vegetation or blood clot going to the lungs can cause a pulmonary embolism (PE) and lung damage. A PE is a sudden blockage in a lung artery.

Other lung complications include pneumonia and a buildup of fluid or pus around the lungs.

Kidneys. IE can cause kidney abscesses and kidney damage. The infection also can inflame the internal filtering structures of the kidneys.

Signs and symptoms of kidney complications include back of side pain, blood in the urine, or a change in the color and amount of urine. In some cases, IE can cause kidney failure.

Spleen. The spleen is an organ located in the left upper part of the abdomen near the stomach. In some people who have IE, the spleen enlarges (especially in people who have long-term IE). Sometimes emboli also can damage the spleen.

Signs and symptoms of spleen problems include pain or discomfort in the upper left abdomen and/or left shoulder, a feeling of fullness or the inability to eat large meals, and hiccups.

What are the Signs and Symptoms of Endocarditis?

Infective endocarditis can cause a range of signs and symptoms that can vary from person-to-person. Signs and symptoms also can vary over time in the same person.

Signs and symptoms of IE may include:

  • Flu-like symptoms, such as fever, chills, fatigue, aching muscles and joints, night sweats, and headaches
  • Shortness of breath or a cough that won't go away
  • A new heart murmur or a change in an existing heart murmur
  • Skin changes such as:
    • Overall paleness
    • Small, painful, red or purplish bumps under the skin, on the fingers or toes
    • Small, dark, painless flat spots on the palms of the hands or the soles of the feet
    • Tiny spots under the fingernails, on the whites of the eyes, on the roof of the mouth and inside of the cheeks, or on the chest. These spots are from broken blood vessels
  • Nausea, vomiting, a decrease in appetite, a sense of fullness with discomfort on the upper left side of the abdomen, or weight loss with or without a change in appetite
  • Blood in the urine
  • Swelling in the feet, legs, or abdomen

Source: National Heart, Lung, and Blood Institute; National Institutes of Health; U.S. Department of Health and Human Services.

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