Last updated on January 7, 2022

Content By: Dr. Nikita Toshi BDS, Assistant Manager (Medical Review), Dr. Ritu Budania MBBS, MD (Pharmacology) Head, Medical Affairs

Last updated on January 7, 2022

Overview


As you may already know, the heart is one of the most important organs in the body. It helps supply and circulate blood to all parts of the body and is central to human survival. Just like how sometimes we get a throat infection or a stomach bug, did you know that the heart can also get infected the same way?

Endocarditis is an infection of the heart where the inner lining of the heart gets inflamed. Endocarditis treatment is usually administered almost immediately to prevent further complications. Endocarditis can be life-threatening if not diagnosed and treated quickly.

Being diagnosed with a heart condition can be daunting, however, gaining awareness and knowledge about the condition can help you take the right steps towards your treatment and recovery. Read on to know all about the symptoms, causes and endocarditis treatment in India in this comprehensive guide.


Overview


As you may already know, the heart is one of the most important organs in the body. It helps supply and circulate blood to all parts of the body and is central to human survival. Just like how sometimes we get a throat infection or a stomach bug, did you know that the heart can also get infected the same way?

Endocarditis is an infection of the heart where the inner lining of the heart gets inflamed. Endocarditis treatment is usually administered almost immediately to prevent further complications. Endocarditis can be life-threatening if not diagnosed and treated quickly.

Being diagnosed with a heart condition can be daunting, however, gaining awareness and knowledge about the condition can help you take the right steps towards your treatment and recovery. Read on to know all about the symptoms, causes and endocarditis treatment in India in this comprehensive guide.


Written by

Dr. Nikita Toshi

BDS, Assistant Manager (Medical Review)

Reviewed by

Dr. Ritu Budania

MBBS, MD (Pharmacology) Head, Medical Affairs

Infective endocarditis or bacterial endocarditis is a condition where the inner lining of your heart’s valves and chambers, known as endocardium, get inflamed due to an infection (usually bacterial, can be fungal as well).

How does it occur?

It usually occurs when bacteria or other germs spread through the blood from infections affecting other parts of the body such as your mouth and attach to already weak or damaged areas of your heart. Endocarditis or heart infections, in general, are therefore less common in those with healthy hearts.

How common is it?

Previously, endocarditis diagnosis was common in people aged before their 30s or 40s! However, with more patients having pacemakers and artificial heart valves in their bodies, the average age at onset has climbed to 50 years. With that being said, signs of endocarditis or infective endocarditis symptoms are experienced by 3 – 10 out of 1 Lakh people every year.

Infective endocarditis affects 14.5 cases per 100000 patient-years in India, which is very high compared to the Western incidence which is around 1.7 – 6.2 cases per 100000 patient-years.

Types of Endocarditis seen in Indian Patients

There are two main types of endocarditis – acute bacterial endocarditis and subacute bacterial endocarditis.

Acute Bacterial Endocarditis is when the endocarditis symptoms develop suddenly and become life-threatening within a few weeks.

Subacute Bacterial Endocarditis attacks the system subtly and gradually over a period of several months or even years, if not diagnosed early. This stage can also be life-threatening if left untreated. However, since the growth of infection is at a lower rate, doctors can easily detect and treat it with antibiotics.

In a Nutshell
    • Endocarditis is an inflammation that affects the inner surface of your heart’s chambers and valves, known as endocardium.
    • Infective endocarditis symptoms are caused by bacterial or viral infections entering through other parts of the body, which travel to the heart via the bloodstream.
    • If the symptoms are not recognised and treated promptly, bacteria can grow at a faster rate.

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Infective endocarditis is caused by bacteria that get into the bloodstream and travel to your heart. They latch onto damaged parts of your heart and cause inflammation. Some ways that bacteria and germs can enter the bloodstream and affect the heart include: 

  • During dental surgery procedures (if carried out inappropriately)
  • Oral/gum infections
  • Unsterilized surgical equipment or needles 
  • Cuts and wounds
  • Infections that form due to IV procedures or catheters
  • Infections from a surgical wound
  • Sexually transmitted diseases

Infective endocarditis may also occur as a result of existing underlying conditions such as:

  • Sinuses or throat infections
  • Lung infection like pneumonia
  • Heart valve problems
  • Diabetes
Who is at risk of developing infective endocarditis?

In some cases, endocarditis symptoms may not be diagnosed promptly because the person does not have any symptoms. In others, people with an existing heart condition are at a higher risk of developing infective endocarditis as compared to those without one. Some common conditions that increase your risk of Infective Endocarditis include:

Infections on artificial heart valves – Bacteria can attach to the prosthetic valves at the time of surgery or later on, causing Infective Endocarditis.

Damaged heart valves – A patient with weakened, damaged or older heart valves due to an underlying condition is more likely to get infective endocarditis than one with a young, healthy valve.

Infections from heart transplants – If you have had a transplant, Infective Endocarditis is common because the IV lines used to administer immunosuppressant drugs can let bacteria into your blood.

Implanted heart device – Infections around the device such as a pacemaker used to treat heart failure or irregular heartbeat can increase your chance of getting Endocarditis.

Congenital heart defects – CHDs like a heart murmur, aortic stenosis and abnormal heart valve can increase your risk of Infective Endocarditis. Aortic stenosis treatment involves taking medications, adopting lifestyle changes and undergoing surgical procedures like aortic valve repair or aortic valve replacement.

Poor dental health – Infections of the gums and teeth can lead to Infective Endocarditis.

Previous endocarditis – Having had one episode of Infective Endocarditis increases your risk for this condition, especially if you acquired infection in your heart valves or a prosthetic valve.

Illegal drug use (IV drugs) Bacteria can enter your bloodstream directly through needle punctures used to inject drugs into the veins and increase the risk of heart infections.

Infections from catheters – A long-term central venous line or other intravenous catheters that remain in place for more than two weeks increase the risk of Infective Endocarditis.

Older age – Infective Endocarditis is more likely to occur in people over the age of 50. Infection-causing bacteria can be eliminated from your body by healthy white blood cells but this process slows down as you get older.

Speak to your doctor if you feel you might be at risk of developing a heart infection. The earlier the risk is identified and lowered, the better for your heart health in the long run.

How can infective endocarditis be prevented?

The following measures can help in reducing the risk of infective endocarditis to a significant extent:

Maintain good oral health Follow oral health practices such as flossing your teeth regularly, checking if your dentures fit properly and visiting your dentist once every six months. Generally, maintaining good oral hygiene is known to be more effective in helping prevent infective endocarditis than taking preventive medications during certain medical procedures.

Take preventive medications People who are at a higher risk of developing infective endocarditis can considerably benefit from taking preventive medications before undergoing certain types of medical procedures. It is recommended to consult your doctors to identify the right kind of medications and the correct dosage. 

Keep in mind that not all cases of infective endocarditis can be prevented with awareness about the risk factors. Get in touch with your doctor if you have symptoms of infective endocarditis (discussed in the next section) without any delay, as early diagnosis can pave the way for easier and effective treatment.

In a Nutshell
    • There are several risk factors that can increase your risk of Infective Endocarditis, such as old age, a history of endocarditis, renal failure and smoking.
    • Infective Endocarditis can affect people with a wide range of conditions such as rheumatic fever, artificial heart valves and poor dental health.
    • Infectious endocarditis is more common in people over the age of 50, hence tracking your health is very important.

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Endocarditis symptoms can arise gradually or suddenly. This is purely based on: 

  • the type of bacteria or germs that may be causing the heart infection. 
  • the effect of an underlying heart problem.

Endocarditis symptoms may vary from individual to individual.

Infective Endocarditis signs and symptoms in Indian adults can include:

Fever & Flu-like symptoms – Infective endocarditis is often associated with fever coupled with chills and night sweats. The average temperature in Infective Endocarditis is generally above 38°C (100.58 °F).

Unexplained weight loss – This condition leads to rapid unintentional weight loss.

Weakness or fatigue – Infective Endocarditis can worsen a pre-existing heart disease, which may make some activities harder for you to do than before your infection developed.

Chest pain (especially when taking breaths) – Chest pain is another common symptom especially while breathing. It usually occurs only in one location – often over the left side of your chest.

Shortness of breath – Endocarditis patients sometimes experience shortness of breath heart infections that affects the amount of oxygenated blood circulating through their body.

Blood in urine – Some patients may notice blood in their urine, which can be a sign of Infective Endocarditis or another kidney infection.

Red skin rash – Infection-related rashes are a sign of Infective Endocarditis. It may appear as small, flat red spots on the trunk of your body or face and may quickly grow in size before turning purple and then brown.

White spots in the mouth or tongue – Infection in your heart can cause white spots to appear on the inside of your mouth and tongue if it spreads. Infective Endocarditis patients may also notice that they have a metallic taste in their mouths or food that seems not as appealing anymore.

Pain and swelling in joints – Endocarditis may sometimes cause joint pain and swelling called Osler nodes, especially in the fingers and toes.

Heart Murmur – Endocarditis may cause abnormal heart sounds due to damage to heart valves.

Some people with endocarditis don’t realize how sick they are until it’s too late to reverse their condition – leading to heart failure, paralysis, memory loss, numbness in arms or legs if the infection spreads beyond your body’s cardiovascular system into surrounding muscle tissue. These are signs that you may require more aggressive infective endocarditis treatment as quickly as possible. Therefore, speak to your doctor if and when you experience even the earliest of signs to rule out your diagnosis.

In a Nutshell
    • The primary endocarditis symptoms include pain and swelling of joints, chest pain, fever and fatigue.
    • Infected Heart Valve Disease also causes other symptoms like shortness of breath or red rash around ankles & feet spreading to body parts.
    • The symptoms may show up days or weeks before Infective Endocarditis is diagnosed.

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If your doctor notices you may be showing signs and symptoms of infective endocarditis, especially when you also fall under the risk bracket, he may recommend a few tests to rule out the chances of it being a heart infection.

An ​endocarditis diagnosis may include one of the following tests:

Physical Exam – An important aspect of diagnosis – your doctor will examine clinically and check your pulse, blood pressure, body weight, heart sounds, breathing and other parameters along with a detailed medical history to understand your condition.

Blood Tests:

  • A complete blood count (CBC) will show any changes in haemoglobin, RBCs and white blood cell levels due to Endocarditis.
  • Blood Culture and sensitivity testing – Infections caused by bacteria may be detected through lab tests like cultures, where doctors check for specific germs in samples taken from body tissues or blood. This can help determine which antibiotics work best against the bacteria causing the infection
  • Some other blood tests as needed.

Echocardiogram – Endocarditis Infection signs can show up on an echocardiogram, giving doctors a clear picture of how serious your condition is and the type of treatment you’ll need. The test uses ultrasound to take pictures inside your heart using sound waves which can be used to spot blood clots or abnormal valves that may cause bacterial endocarditis.

Electrocardiogram – An endocarditis diagnosis may also include checking for abnormal changes in the electrical activity of your heart, known as arrhythmias. An electrocardiogram (EKG) is used to measure these electrical waves and spot any abnormalities that could indicate bacterial endocarditis.

Chest X-ray – The symptoms can become worse once it spreads outside your heart causing infections in other organs that can be seen on chest x-rays.

CT and MRI Scans – Infective Endocarditis Infection symptoms can lead to abscesses or bone marrow infections that will show up on CT and MRI scans, which use X-rays and magnetic pulses to create detailed images of your body.

In a Nutshell
    • Doctors may perform a physical examination, x-rays, MRI scans, ECG, etc, to diagnose Infective Endocarditis.
    • These tests help the doctors to gain a better understanding on the severity of the condition and what kind of treatment to proceed with.
    • It is also very important to stay mindful and positive during all these treatments for a better recovery.

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If your doctor feels that you may be showing early signs of a heart infection like endocarditis, he may advise the treatment based on the severity of your condition. Following treatment options can be considered by your doctor:

Antibiotics (IV or oral medications) – Intravenous (IV) antibiotics may be prescribed for a considerable duration (often several weeks or longer). The type of medication and duration is dependent on the type of bacteria causing endocarditis. Oral medications may also be prescribed as part of your initial Infective Endocarditis treatment to ensure any harmful germs have been killed before undergoing more complex procedures like open-heart surgeries to treat the infection further.

Surgical treatmentsYour doctor may recommend heart valve surgery as an infective endocarditis treatment option. This is usually done to treat aggressive endocarditis or as a damaged valve replacement measure.

Preparing for the Surgery

Before surgery, you’ll be given some medications depending upon your condition. Blood tests may also be done prior to infective endocarditis treatment in India, checking for signs that the preventive antibiotics prior to surgery are working.

How much does an infective endocarditis surgery cost in India?

Cardiovascular surgeries like open-heart surgery, valve replacement surgery, etc, can range from ₹1.5 – 7 lakhs in India. However, these costs again are dependent on the hospital and the city you may be living in.

Recovery and Post Operation: What to do, and what not to do?

Preventing a relapse requires patients to be more aware of their surroundings and also make a few changes to their lifestyle. Here are a few suggestions that your doctor might recommend in order to protect yourself from another bout of endocarditis:

  • Do not smoke, drink alcohol or take recreational drugs – as these can cause additional damage.
  • Avoid heavy lifting for a long time after endocarditis surgery (usually several weeks).
  • Avoid sharing utensils, towels and dishes with people who could be infected, even family members.
Do’s Don’ts
Maintain excellent oral and dental hygiene. Schedule regular check-ups at the dentist to keep your teeth and gum health in check. Smoke or drink
Schedule regular checkups with your cardiologist to keep your heart health in check. Take recreational/illegal drugs
Wash all your fruits and vegetables thoroughly before consuming them. Lift heavy weights – especially after surgery
Maintain proper personal hygiene by showering daily, thoroughly washing and disinfecting any clothes, towels, underwear and even utensils that you use. Miss or skip the doses of antibiotic medications prescribed by your doctor for treatment of any infection.
Take good care of your skin. Clean any cuts and wounds immediately to avoid the chance of infection. Share utensils, towels or any personal hygiene products with anyone who you think may be sick.

If preventive measures are not followed properly, some of the complications that might arise include:

  Abnormal heart rhythms

  Blood clots

  Organ injury

  Stroke

  Heart failure

Therefore, lower your risk of developing heart infections like endocarditis by following the given measures:

Being aware of the condition, its symptoms and how it is caused so that you can be prepared for any emergencies.

Maintaining good oral hygiene, taking good care of your gums and teeth and scheduling regular visits to the dentist.

Take good care of your skin by regularly cleaning wounds and cuts (especially if you have diabetes) to prevent any infection from getting into the bloodstream.

How to care for someone diagnosed with endocarditis?

People diagnosed with Infective Endocarditis will have to rest a lot during the initial days of treatment as they can feel fatigued and tired. Here are some more ways you can offer support and help along their journey to recovery:

Help them with physical tasks around the house. 

Help them to take their medication on time

Accompany them to doctor visits 

Share stories, do tasks together that can help lift their spirits and improve their mental health.

Join a support group together

The recovery time after infective endocarditis treatment can vary depending on the patient condition and type of endocarditis treatment done in India. However, showing that you care and them knowing that they have your support and help can go a long way in speeding up their recovery as well.

In a Nutshell
    • Doctors may prescribe antibiotics during the initial stages of Infective endocarditis treatment.
    • Surgery may be prescribed if the symptoms worsen over time or if the symptoms are diagnosed late.
    • Patients must follow a healthy lifestyle, including eating healthy and regular visits to the doctor.
    • Preventing IE starts with your personal hygiene. Make sure you take care of your oral health as bacteria can build up in your mouth and travel inside your body through the bloodstream, affecting your heart.

Supplement your diet for Infective Endocarditis with the right medicines.
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Is surgery necessary for infective endocarditis?

Infective endocarditis treatment in India usually involves medications for a few months post-diagnosis, depending on how severe your condition is. Surgery is required in severe cases where your valves have been completely damaged. However, it is advised to speak with your doctor about the best treatment plan suited to the severity of your condition.

Can infective endocarditis be cured with antibiotics?

Your doctor may prescribe antibiotics to help manage the condition in its initial stages or as a preventive measure prior to surgery. Medications may also be administered for several months after surgery to ensure complete recovery and prevent damage to your heart valves. It is best to speak with your doctor about the best treatment plan for you.

What type of bacteria causes infective endocarditis?

Infective endocarditis Infection is usually caused by bacteria like streptococcus and staphylococcus.

What is the general cost of treatment of infective endocarditis in India?

The cost of treatment of infective endocarditis in India usually ranges from ₹1 lakh to over ₹7lakhs. This largely depends upon the hospital and the type of surgery recommended.

What kind of problems can occur with infective endocarditis?

Infective endocarditis can lead to serious problems like heart damage and dysfunction, stroke, paralysis, aneurysm (a bulging of a blood vessel), heart attack, heart failure or even death in worst cases if left untreated.

It is worth noting that the difference between heart attack and heart failure is heart attack occurs when the blood flow to the heart is suddenly cut off, while heart failure happens when the heart is unable to pump blood as efficiently as it should.

Can infective endocarditis occur from fungi?

Yes, endocarditis can also be caused by fungi. Infections of this type are not as common as those caused by bacteria but they do require special treatment – which may include antifungal therapy and surgery.

Is infective endocarditis life-threatening?

Yes, Infective Endocarditis Infection can be fatal if untreated. Infections of this type are most common among people with pre-existing health conditions like congenital valve defects, arrhythmias or peripheral vascular disease.

What are the long term effects of untreated infective endocarditis?

Infective endocarditis Infection can be fatal if it is not treated. It can also cause heart failure (when your heart doesn’t pump enough blood to meet the body’s needs), paralysis, stroke, aneurysm (a bulging of a blood vessel) or death.

What measures for prevention of infective endocarditis can one follow?

The following measures can be considered:

  • It is important to follow oral health practices such as flossing your teeth regularly, checking if your dentures fit properly and visiting your dentist once every six months.
  • People who are at a higher risk of developing infective endocarditis are advised to take preventive medications before undergoing certain types of medical procedures, after consulting with their doctor.

Doctor's Section

Dr. Nikita Toshi
Dr. Nikita works with PharmEasy as a medical content writer. She completed her B.D.S. from Rama Dental College, Hospital and Research Center, Kanpur in 2013 with an excellent academic record. Holding a clinical experience of 7 years in dental practice, she has worked at Rameti Oral and Maxillofacial Centre, Allahabad as Associate Dental Surgeon and Raipur Institute of Medical Sciences as Junior Resident. Her clinical skills include bleaching, restorations, R.C.T, Re R.C.T., single visit R.C.T. and F.P.Ds, dental extractions, minor OT procedures, oral prophylaxis, curettage, root planing, and perio-splint. Dr. Nikita frequently speaks on dental health talks organized at schools and other institutes to help in raising awareness on dental health in society. She has also written a research paper published in a reputed journal.

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Dr. Ritu Budania
Dr. Ritu Budania heads PharmEasy’s medical content and catalogue management teams. She did her MBBS from Topiwala National Medical College, Mumbai; followed by post-graduation in MD Pharmacology from Government Medical College, Nagpur. She was awarded a bronze medal for topping the Maharashtra University of Health Sciences in her MD. She has six publications in international and national medical journals. She is also an esteemed industry speaker in the field of pharmacology and has been invited as chief guest/speaker in several medical / pharmacy colleges. She has also helped author the World Health Organisation’s document on ‘Desk View and Situation analysis of Clinical Trials in India’ and helped in signal detection activities for the Pharmacovigilance Programme of India. She holds expertise in medical writing, ethics, and GCP in biomedical research, advanced pharmacovigilance, and biostatistics.

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