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Cut paper illustration of a white tooth with a tiny red heart in the corner, on a blue background.
Cut paper illustration of a white tooth with a tiny red heart in the corner, on a blue background.

What Is Endocarditis?

When Germs Invade the Heart

Endocarditis is a rare but life-threatening heart infection that can lead to heart failure and an increased risk of stroke. It is important to be aware of the risks and signs of endocarditis, as well as how to prevent it. Early diagnosis and treatment are crucial for preventing serious complications from endocarditis.

Understanding Endocarditis

Endocarditis is caused by germs, mostly bacteria but sometimes fungi like Candida, that enter the bloodstream, settle and then multiply in the heart's endocardium, the lining of the heart's chambers and valves. As they multiply, these germs can damage the valves and form small blood clots that break loose, move through the blood and block small arteries.

"Your mouth has bacteria in it. Always. That's just a normal part of living. And when you do something to your teeth even as simple as brushing your teeth, you release a little bit of bacteria into the bloodstream," says Douglas R. Johnston, MD, chief of Cardiac Surgery at Northwestern Medicine. "Usually, your body is pretty good at getting rid of bacteria. But if you overload your body's ability to get rid of it — this can happen with teeth cleaning or with major dental work — and you have something abnormal on the inside of your heart, bacteria can latch onto the inside and cause a serious infection." He adds that your teeth are the most common location for infection-causing bacteria to get inside your heart.

Risk Factors of Endocarditis

While endocarditis is rare, certain people have a greater risk of developing it.

Normally, your immune system kills germs in your bloodstream before causing harm. However, certain conditions can create openings or weaknesses in your heart, making it more vulnerable to infection, including:

  • Damaged heart valves: This can be due to congenital heart defects (defects you were born with), rheumatic heart disease (scarring from rheumatic fever) or degenerative valve disease (age-related deterioration).
  • Artificial heart valves: Even though they can be lifesaving, artificial or prosthetic valves are more susceptible to infection than natural valves.
  • Cardiac implants: Germs can attach to a pacemaker or other implanted device.
  • History of endocarditis: If you had endocarditis once, your risk of developing it again increases.
  • Stenosis (narrowing) of the aortic valve: Stenosis is typically from age-related calcification of the valve.

Beyond direct heart issues, other conditions and procedures can introduce germs into your bloodstream and potentially lead to endocarditis. These include:

  • Poor dental hygiene: If you don't brush and floss regularly, bacteria can grow inside your mouth and may enter your bloodstream through a cut.
  • Dental work: Dental procedures, including routine dental cleaning and tooth removal, may allow bacteria to enter your bloodstream through a cut in your mouth.
  • Intravenous (IV) drug use: Injections with needles contaminated with bacteria or fungi can lead to endocarditis.
  • Medical procedures: Urinary catheters and certain surgeries can introduce bacteria into the bloodstream.
  • Chronic conditions: Diabetes, weakened immune system and skin infections can increase your risk.

"A routine dental cleaning can disturb the gums and the teeth as much as a root canal or other major dental procedure," says Dr. Johnston. "If your dentist doesn't ask you and you have a heart condition, make sure they know and that you're taking the right medication in advance."

Prevalence of Endocarditis

Endocarditis is not common. Each year, an average of five out of 100,000 people in the United States will be diagnosed with it. Although rare, endocarditis has nearly a 40% death rate within the first year of diagnosis. Furthermore, depending on the type of germs causing the infection, endocarditis can develop suddenly and become life-threatening within days.

Symptoms of Endocarditis

Signs of an endocarditis infection may include:

  • Fever above 100 degrees F
  • Sweats or chills, particularly night sweats
  • Blood colored marks under your nails
  • Fatigue
  • Shortness of breath
  • Muscle and joint aches
  • Poor appetite or weight loss
  • Persistent cough that lasts more than two days
  • Swelling in the feet, legs or belly

Preventing Endocarditis

While some risk factors are unavoidable, such as age and congenital heart defects, there are steps you can take to minimize your chances of endocarditis:

  • Maintain good oral hygiene: Brush and floss regularly to reduce oral bacteria.
  • Inform your dentist: Let your dental team know about any heart conditions, artificial valves, cardiac implants or a previous endocarditis diagnosis well before a visit. In certain cases, your dentist may recommend a preventative antibiotic before dental procedures.
  • Carry a wallet identification card: If you meet the requirements for preventative antibiotics for dental treatment or oral surgery, your cardiologist or other healthcare professional may give you an American Heart Association wallet card to share with your oral health care team.
  • Hand washing: Wash your hands frequently and treat skin infections promptly.
  • Manage chronic conditions: Work with your physician to manage diabetes and maintain a healthy immune system.
  • Avoid dirty needles: Do not engage in illicit intravenous (IV) drug use.

Early Detection Is Key

If you experience any symptoms of endocarditis, especially after a medical procedure or dental work, consult your primary care clinician or cardiologist immediately. It is critical to get diagnosed and treated as soon as possible

Learn more about your heart health by taking a heart health assessment.