Diagnosis

Your doctor may suspect endocarditis based on your medical history, signs and symptoms you're experiencing, and your test results. A diagnosis of endocarditis is usually based on several factors instead of a single positive test result or symptom.

Your doctor may order several tests to help make a positive diagnosis, including:

  • Blood tests. A blood culture test is used to identify any bacteria or fungi in your bloodstream, and it's the most important test your doctor will perform. Blood tests can also help your doctor identify certain conditions that can be a sign of endocarditis, such as anemia — a shortage of healthy red blood cells.
  • Echocardiogram. An echocardiogram uses sound waves to produce images of your heart while it's beating. This test is often used to check for signs of infection. Your doctor may use two different types of echocardiograms to help diagnose endocarditis.

    In a transthoracic echocardiogram, sound waves directed at your heart from a wandlike device (transducer) held on your chest produce video images of your heart in motion. This test can help your doctor look at your heart's structure and check it for any signs of infection or damage.

    Doctors may conduct another type of echocardiogram called a transesophogeal echocardiogram to get a closer look at your heart valves. During this test, a small transducer attached to the end of a tube is inserted down the tube leading from your mouth to your stomach (esophagus). This test can allow your doctor to get much more detailed pictures of your heart than is possible with a transthoracic echocardiogram.

  • Electrocardiogram (ECG). While an ECG isn't specifically used to diagnose endocarditis, it can show your doctor if something is affecting your heart's electrical activity. During an ECG, sensors that can detect your heart's electrical activity are attached to your chest, arms and legs. This test is used to measure the timing and duration of each electrical phase in your heartbeat.
  • Chest X-ray. X-ray images help your doctor see the condition of your lungs and heart. Your doctor can use X-ray images to see if endocarditis has caused your heart to enlarge or if any infection has spread to your lungs.
  • Computerized tomography (CT) scan or magnetic resonance imaging (MRI). You may need a CT scan or an MRI scan of your brain, chest or other parts of your body if your doctor thinks that infection has spread to these areas.

Treatment

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

Antibiotics

If you have endocarditis, your doctor might recommend high doses of intravenous (IV) antibiotics in the hospital. Your doctor will use blood culture tests to help identify the organism that's causing your infection. Based on the results of your blood tests, your doctor will choose the most appropriate antibiotic or combination of antibiotics to fight the infection.

You'll generally spend a week or more in the hospital when you start taking IV antibiotics. This gives your doctor time to see if the antibiotics are working against your infection. You'll usually take antibiotics for several weeks to clear up the infection.

Once your fever and the worst of your signs and symptoms have passed, you might be able to leave the hospital and continue IV antibiotic therapy with visits to your doctor's office or at home with home-based care. You'll still need to see your doctor regularly to make sure your treatment is working.

It's important to tell your doctor about any signs or symptoms that may mean your infection is getting worse, such as:

  • Fever
  • Chills
  • Headaches
  • Joint pain
  • Shortness of breath

Also, if you develop diarrhea, a rash, itching or joint pain, let your doctor know as soon as possible. These signs and symptoms may indicate you're having a reaction to your prescribed antibiotic.

If you have shortness of breath or swelling in your legs, ankles or feet after you start antibiotic treatment, see your doctor immediately. These signs and symptoms can be indicators of heart failure.

Surgery

If the infection damages your heart valves, you may have symptoms and complications for years after treatment. Sometimes surgery is needed to treat persistent infections or to replace a damaged valve. Surgery is also sometimes needed to treat endocarditis that's caused by a fungal infection.

Depending on your condition, your doctor may recommend either repairing your damaged valve or replacing it with an artificial valve made of cow, pig or human heart tissue (biological tissue valve) or man-made materials (mechanical valve).

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Lifestyle and home remedies

If you're at risk of endocarditis, let all of your health care providers know. You may want to request an endocarditis wallet card from the American Heart Association. Check with your local chapter or print the card from the association's website.

Preparing for your appointment

The first doctor you see will likely be your family doctor or an emergency room physician. Or, when you call to set up an appointment, you may be referred to a doctor 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 experiencing. Be sure to note how long you've had particular symptoms. If you've had similar symptoms that have come and gone in the past be sure to include that information.
  • Make a list of your key medical information. Your doctor will need to know about any other recent health problems you've had and the names of all prescription and over-the-counter medications and supplements you're taking.
  • Find a family member or friend who can come with you to the appointment. Someone who accompanies you can help remember what your doctor 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 doctor 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 doctor 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 intravenous 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?
March 06, 2018
References
  1. Endocarditis. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/endo/. Accessed March 3, 2017.
  2. Karchmer A. Infective endocarditis. Harrison's Principles of Internal Medicine. http://accessmedicine.mhmedical.com/content.aspx?sectionid=79733720&bookid=1130&... Accessed Feb. 24, 2017.
  3. Sexton DJ, et al. Epidemiology, risk factors, and microbiology of infective endocarditis. http://www.uptodate.com/home. Accessed Feb. 24, 2017.
  4. Sexton DJ, et al. Clinical manifestations and evaluation of adults with suspected native valve endocarditis. http://www.uptodate.com/home. Accessed Feb. 24, 2017.
  5. Spelman D, et al. Complications and outcomes of infective endocarditis. http://www.uptodate.com/home. Accessed March 3, 2017.
  6. Sexton DJ, et al. Antimicrobial therapy of native valve endocarditis. http://www.uptodate.com/home. Accessed March 3, 2017.
  7. What is infective endocarditis? American Heart Association. http://www.heart.org/HEARTORG/Conditions/More/HeartValveProblemsandDisease/Heart-Valves-and-Infective-Endocarditis_UCM_450448_Article.jsp#.WOUJ42czXIV. Accessed March 14, 2017.