Endocarditis

Endocarditis is a serious infection of the inner lining of the heart, most often affecting the heart valves. It occurs when bacteria, or less commonly fungi, enter the bloodstream and attach to damaged or artificial valves. The infection can cause fevers, heart problems, and complications in other parts of the body, making early diagnosis essential.

At The Medical Group of New Jersey, our infectious disease specialists provide expert evaluation, coordinated cardiac care, and advanced antimicrobial therapy to treat endocarditis and prevent long-term heart damage.

Symptom Onset & Initial Evaluation

Endocarditis can develop gradually over weeks or appear suddenly, depending on the type of bacteria involved. Because symptoms can be vague at first, patients may not initially realize that their heart is affected.

Common symptoms of endocarditis include:

• Persistent fever or chills
• Fatigue or feeling unusually tired
• Shortness of breath
• Night sweats
• Unexplained weight loss
• New or worsening heart murmur
• Joint or muscle pain
• Skin changes (small red or purple spots on fingers, toes, or under nails)

Some patients, especially older adults, may present with confusion, worsening heart failure, or strokes caused by small clots traveling from the infected valve.

Evaluation

During your visit, your infectious disease specialist will:

• Review recent infections, dental work, IV drug use, or procedures that could introduce bacteria into the bloodstream
• Ask about heart conditions, artificial valves, or past valve surgery
• Perform a physical exam focused on heart sounds, skin findings, and circulation
• Explain the diagnostic process step-by-step to minimize anxiety

Because endocarditis can evolve rapidly, early evaluation helps prevent serious complications.

Diagnosis & Risk Assessment

Diagnosis relies on identifying both the infection and its impact on the heart.

Testing may include:

• Blood cultures (taken in multiple sets) to identify the organism
• Echocardiogram (ultrasound of the heart) to look for vegetations—infected growths on the valves
• Transthoracic echo (TTE) as an initial scan
• Transesophageal echo (TEE) for clearer, more detailed images
• Complete blood count (CBC)
• Inflammatory markers (CRP, ESR)
• Kidney and liver function tests
• EKG and chest X-ray to evaluate heart and lung status

If infection spreads beyond the heart, additional imaging, such as CT scan or MRI, may be ordered.

Risk Assessment Includes:

• Determining whether the infection is native valve or prosthetic valve
• Identifying complications such as heart failure, emboli, or abscesses
• Assessing the need for surgical intervention

Your care team will review results with you and explain how they guide your treatment plan.

Treatment & Management

Endocarditis requires prompt and aggressive treatment to eliminate infection and protect the heart. Your infectious disease specialist at The Medical Group of New Jersey will work closely with a cardiologist to develop a treatment plan that is personalized to your needs.

Treatment for endocarditis typically includes:

Antibiotic Therapy

• Intravenous (IV) antibiotics are the primary treatment for endocarditis
• Therapy typically lasts 4 to 6 weeks, depending on the organism causing the infection
• Medications are often administered through a PICC line, either in the hospital or at home
• Antibiotics are tailored based on culture results and drug sensitivities

Your specialist will closely monitor your progress and adjust medications as needed.

Supportive Care

• Treatment of symptoms such as fever, pain, or shortness of breath
• Management of complications like heart failure or kidney injury
• Coordination with cardiologists and cardiac surgeons

Surgical Treatment

Surgery may be needed if:

• There is severe valve damage
• Infection does not respond to antibiotics
• Large vegetations pose a stroke risk
• There is a prosthetic heart valve infection
• Heart failure develops

Your care team will explain surgical recommendations clearly and connect you with the appropriate specialists.

Monitoring & Follow-Up

Ongoing follow-up is vital to ensure the infection resolves and the heart heals properly.

During routine visits, your specialist will:

• Repeat blood cultures to confirm the infection has cleared
• Monitor kidney and liver function
• Assess heart function with follow-up echocardiography
• Review symptoms such as fatigue or shortness of breath
• Help coordinate cardiac rehabilitation when needed
• Provide education on preventing future infections

Many patients continue antibiotics at home with support from home health visiting nurses or home infusion services. Our team at The Medical Group of New Jersey ensures you are supported throughout the entire recovery process.

Prognosis & Preventive Care

With early diagnosis and expert care, many patients recover well from endocarditis. Prevention plays a key role in avoiding future episodes.

Prevention Strategies Include:

• Good dental hygiene and regular dental care
• Antibiotic prophylaxis before certain dental procedures (for eligible patients)
• Avoiding IV drug use
• Prompt treatment of skin wounds and infections
• Managing chronic heart and valve conditions
• Regular follow-up with cardiology if you have a prosthetic valve or congenital heart disease