Cardiology is the medical specialty focused on the heart and the cardiovascular system. It involves the diagnosis, treatment, and prevention of conditions affecting the heart and blood vessels. These conditions include coronary artery disease, heart failure, arrhythmias (irregular heartbeats), and valve disorders. The field covers a broad spectrum, from congenital heart defects present at birth to acquired conditions like heart attacks.
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Endocarditis is notoriously difficult to diagnose in its early stages because its symptoms can mimic many other common illnesses. It is often called “the great imitator.” A patient might feel like they have a persistent flu that just won’t go away. This vague presentation can lead to dangerous delays in treatment. Recognizing the combination of general flu-like symptoms with specific signs of heart or circulation issues is key to catching the disease early.
Identifying who is at risk is equally important. While anyone can theoretically get endocarditis, the vast majority of cases occur in people with specific predisposing factors. Knowing if you fall into a high-risk category allows you to be more vigilant. If you have a known heart condition and develop an unexplained fever, knowing your risk helps you advocate for the right tests sooner rather than later.
The most common symptom of endocarditis is fever. It is present in practically every case. In acute endocarditis, the fever is usually high (over 102°F or 38.9°C) and accompanied by shaking chills. In subacute cases, the fever may be low-grade and fluctuate over several weeks. Along with the fever, patients typically experience profound fatigue, aching muscles and joints, night sweats, and headaches.
Because these symptoms look exactly like the flu or a serious viral infection, patients often try to wait it out at home. The key difference is persistence. A viral flu usually resolves in a week or so. Endocarditis symptoms linger and often worsen over time. Significant unexplained weight loss and a loss of appetite are also common as the body burns energy trying to fight the chronic infection.
A new or changed heart murmur is a hallmark sign of endocarditis. A murmur is an extra sound heard during the heartbeat, caused by turbulent blood flow. As the infection damages the heart valves—eating away tissue or preventing them from closing—blood starts to leak backward or struggle to move forward. This creates a “whooshing” noise that a doctor can hear with a stethoscope.
If a patient already has a heart murmur, any change in its sound or loudness should be taken seriously. For those who have never had one, a new murmur accompanied by fever is highly suspicious. While patients cannot hear themselves, knowing that valve damage is a primary consequence of the disease highlights the importance of a physical exam when symptoms persist.
Endocarditis can leave telltale signs on the skin and nails due to small clumps of bacteria breaking off and blocking tiny blood vessels. These signs are classic but rare. One such sign is petechiae—tiny red or purple spots that look like a rash but don’t fade when pressed. These can appear on the skin, inside the mouth, or in the whites of the eyes.
Other specific signs include splinter hemorrhages, which look like dark, thin lines under the fingernails or toenails, resembling wood splinters. Osler’s nodes are painful, red, raised bumps found on the pads of the fingers or toes. Janeway lesions are painless, flat red spots on the palms of the hands or soles of the feet. These physical clues are the body’s way of signaling that something is traveling through the bloodstream and causing blockages.
Certain heart conditions create the perfect environment for bacteria to settle. People with artificial (prosthetic) heart valves are at the highest risk because the artificial material is easier for bacteria to stick to than natural tissue. Patients who have had endocarditis before are also at very high risk for a recurrence.
Congenital heart defects (heart problems present at birth) also increase risk, especially if they involve abnormal blood flow that creates turbulence or if they have been repaired with artificial material. Conditions like hypertrophic cardiomyopathy or damage from rheumatic fever can also leave the heart lining rough and vulnerable. If you have any of these conditions, you should consider yourself in the “high-risk” category.
Whether mechanical or tissue, replaced valves are major risk sites. The interface between the sewing ring of the valve and the heart tissue is a common spot for infection to start.
Scar tissue from a past infection leaves the heart surface rough and irregular. This makes it much easier for new bacteria to latch on during a future exposure.
Bacteria need a way to enter into the bloodstream. Certain medical and dental procedures that cause bleeding can provide this entry point. Dental procedures that involve manipulating the gums or the root of the tooth are significant risk factors. This is why dentists ask about heart conditions before cleaning teeth.
Behavioral factors also play a massive role. Intravenous (IV) drug use is a major cause of endocarditis. Using unsterile needles or failing to clean the skin properly injects bacteria directly into the veins. These bacteria often travel straight to the right side of the heart, infecting the tricuspid valve. Additionally, body piercings and tattoos, if done in unsterile conditions, can introduce bacteria into the blood.
Knowing when to see a doctor can be lifesaving. If you are in a high-risk group (artificial valve, congenital heart disease, history of endocarditis) and you develop a fever that lasts more than a few days without an obvious cause like a cold, you should seek medical attention immediately. Do not wait for other symptoms to appear.
Even if you are not high-risk, symptoms like shortness of breath, swelling in the legs, or stroke-like symptoms (sudden weakness, confusion) accompanied by fever require urgent care. These could indicate that the heart valves are failing or that emboli have traveled to the brain or lungs. Early diagnosis prevents the severe complications of valve destruction and organ damage.
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IV drug users inject substances directly into their veins. If the needle, skin, or drug is contaminated with bacteria, those germs go straight to the heart. The tricuspid valve is the first structure they hit, making it the most common site of infection in this group.
It is possible but rare for a healthy person. However, for a high-risk person, an infected cut that is not treated properly can allow bacteria (like Staph) to enter the bloodstream and travel to the heart. Proper wound care is essential.
This is only necessary if you fall into the highest risk category. Guidelines have changed. Currently, antibiotics are recommended for people with artificial heart valves, a history of endocarditis, or certain congenital heart defects. Ask your cardiologist if you qualify.
These are thin, red to reddish-brown lines of blood under the nails. They look like you got a wood splinter stuck under your nail. They are caused by tiny clots damaging the small capillaries in the nail bed and are a sign of endocarditis.
Yes. Clumps of bacteria and cells (vegetation) on the heart valves can break loose. These clumps can travel through the blood to the brain, blocking blood flow and causing a stroke. A stroke is a serious complication that can happen suddenly.
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