Endocarditis

To diagnose endocarditis, a health care provider does a physical exam and asks questions about your medical history and symptoms. Tests are done to help confirm or rule out endocarditis.

Tests

Tests used to help diagnose endocarditis include:

• Blood culture test. This test helps identify germs in the bloodstream. Results from this test help determine the antibiotic or combination of antibiotics to use for treatment.
• Complete blood count. This test can determine if there's a lot of white blood cells, which can be a sign of infection. A complete blood count can also help diagnose low levels of healthy red blood cells (anemia), which can be a sign of endocarditis. Other blood tests also may be done.

• Echocardiogram. Sound waves are used to create images of the beating heart. This test shows how well the heart's chambers and valves pump blood. It can also show the heart's structure. Your provider may use two different types of echocardiograms to help diagnose endocarditis.

  In a standard (transthoracic) echocardiogram, a wandlike device (transducer) is moved over the chest area. The device directs sound waves at the heart and records them as they bounce back.

  In a transesophageal echocardiogram, a flexible tube containing a transducer is guided down the throat and into the tube connecting the mouth to the stomach (esophagus). A transesophageal echocardiogram provides much more detailed pictures of the heart than is possible with a standard echocardiogram.

• Electrocardiogram (ECG or EKG). This quick and painless test measures the electrical activity of the heart. During an electrocardiogram (ECG), sensors (electrodes) are attached to the chest and sometimes to the arms or legs. It isn't specifically used to diagnose endocarditis, but it can show if something is affecting the heart's electrical activity.
• Chest X-ray. A chest X-ray shows the condition of the lungs and heart. It can help determine if endocarditis has caused heart swelling or if any infection has spread to the lungs.
• Computerized tomography (CT) scan or magnetic resonance imaging (MRI). You may need scans of your brain, chest or other parts of your body if your provider thinks that infection has spread to these areas.

Many people with endocarditis are successfully treated with antibiotics. Sometimes, surgery may be needed to fix or replace damaged heart valves and clean up any remaining signs of the infection.

Medications

The type of medication you receive depends on what's causing the endocarditis.

High doses of antibiotics are used to treat endocarditis caused by bacteria. If you receive antibiotics, you'll generally spend a week or more in the hospital so that care providers can determine if the treatment is working.

Once your fever and any severe symptoms have gone away, you might be able to leave the hospital. Some people continue antibiotics with visits to a provider's office or at home with home care. Antibiotics are usually taken for several weeks.

If endocarditis is caused by a fungal infection, antifungal medication is given. Some people need lifelong antifungal pills to prevent endocarditis from returning.

Surgery or other procedures

Heart valve surgery may be needed to treat persistent endocarditis infections or to replace a damaged valve. Surgery is sometimes needed to treat endocarditis that's caused by a fungal infection.

Depending on your specific condition, your health care provider may recommend heart valve repair or replacement. Heart valve replacement uses a mechanical valve or a valve made from cow, pig or human heart tissue (biologic tissue valve).

The first health care provider you see will likely be your primary care provider or an emergency room doctor. You may be referred to a doctor or surgeon trained in diagnosing and treating heart conditions (cardiologist).

What you can do

You can help prepare for your appointment by taking these steps:

• Write down any symptoms you're having. Be sure to note how long you've had them. If you've had similar symptoms that have come and gone in the past, be sure to include that information.
• Make a list of important medical information. Write down any other recent health problems you've had. List the names of all medicines and supplements you're taking. Include their dosages.
• Ask a family member or friend to come with you to the appointment. Someone who goes with you can help remember what your provider says.

It's also important to write down any questions you might have before you get to your appointment. For endocarditis, some basic questions you might want to ask your health care provider include:

• What's the most likely cause of my symptoms?
• What kinds of tests do I need? How do I need to prepare for the tests?
• What treatment do you recommend?
• How soon after I begin treatment will I start to feel better?
• What are the possible side effects?
• Am I at risk of long-term complications from this condition? Will it come back?
• How often will I need follow-up for this condition?
• Do I need to take preventive antibiotics for certain medical or dental procedures?
• I have other medical conditions. How can I best manage these conditions together?

What to expect from your doctor

Your health care provider will probably ask you many questions, including:

• What are your symptoms?
• When did your symptoms start? Did they come on suddenly or more gradually?
• Have you had similar symptoms in the past?
• Are you having difficulty breathing?
• Have you recently had an infection?
• Have you recently had a fever?
• Have you recently had any medical or dental procedures that used needles or catheters?
• Have you ever used drugs?
• Have you recently lost weight without trying?
• Have you been diagnosed with any other medical conditions, especially heart murmurs?
• Do any of your first-degree relatives — such as parents, siblings or children — have a history of heart disease?