From the Guidelines
Endocarditis symptoms include fever, chills, fatigue, muscle and joint pain, night sweats, shortness of breath, chest pain, and heart murmurs, and patients may also experience swelling, unexplained weight loss, and blood in the urine, with some developing specific signs like Osler's nodes, Janeway lesions, Roth spots, and splinter hemorrhages. These symptoms occur when bacteria, fungi, or other germs enter the bloodstream and attach to damaged heart valves or heart tissue, causing inflammation and damage. People with artificial heart valves, previous endocarditis, certain congenital heart defects, or who use intravenous drugs are at higher risk 1. Symptoms may develop gradually over weeks or appear suddenly, depending on the causative organism.
Key Symptoms and Signs
- Fever
- Chills
- Fatigue
- Muscle and joint pain
- Night sweats
- Shortness of breath
- Chest pain
- Heart murmurs
- Swelling in the feet, legs, or abdomen
- Unexplained weight loss
- Blood in the urine
- Osler's nodes (painful red spots on fingers/toes)
- Janeway lesions (painless red spots on palms/soles)
- Roth spots (retinal hemorrhages)
- Splinter hemorrhages under the nails If you experience persistent fever along with any of these symptoms, especially if you have known heart valve problems or other risk factors, seek medical attention immediately as endocarditis requires prompt antibiotic treatment to prevent serious complications like heart failure, stroke, or death 1. The clinical presentation of endocarditis is heterogeneous, with patients often presenting with acute heart failure due to severe valve destruction, but many presenting insidiously, and the physical examination often reveals a new heart murmur, most commonly due to valvular insufficiency, and evidence of heart failure or a myriad of potential embolic and inflammatory/immune-mediated sequelae 1.
Risk Factors
- Artificial heart valves
- Previous endocarditis
- Certain congenital heart defects
- Intravenous drug use It is essential to consider epidemiological factors, history of prior infections, exposure to antimicrobials, clinical course, severity, and extracardiac sites of infection of the current infection in all culture-negative endocarditis cases, and consultation with an infectious diseases specialist is recommended to define the most appropriate choice of therapy 1.
From the Research
Symptoms of Endocarditis
The symptoms of endocarditis can vary, but they often resemble a flu-like illness, making diagnosis difficult 2. Some common symptoms include:
- Fever
- Murmur
- Flu-like illness
- Roth spots
- Janeway lesions
- Osler nodes
Presentation and Evaluation
Patients with endocarditis typically present with non-specific symptoms, and the diagnosis is often considered based on risk factors such as:
- Prior endocarditis
- Structural heart damage
- IV drug use (IVDU)
- Poor immune function
- Nosocomial factors
- Poor oral hygiene 2 A patient with IVDU and fever should trigger consideration of endocarditis, and other keys to diagnosis include multiple sites of infection, poor dentition, and abnormal culture results with atypical organisms.
Diagnostic Tests
Blood cultures and echocardiogram are key diagnostic tests for endocarditis 2, 3. The modified Duke criteria integrate factors predisposing patients to the development of endocarditis, the blood-culture isolates and persistence of bacteremia, and echocardiographic findings, along with other clinical and laboratory information 3. Transesophageal echocardiography has a sensitivity of 76-100% for detecting vegetation, whereas transthoracic echocardiography ranges from 50 to 60% 3.