Endocarditis

Signs and Symptoms

The most common symptom of endocarditis is fever. The fever may be high or low, and it may seem to come and go. Other common symptoms include the following:

• Chills
• Muscle weakness
• Fatigue
• Muscle, joint, and back pain
• Night sweats
• Shortness of breath
• Cough
• Unnatural pallor
• Weight loss
• Heart murmur
• Painful spleen or abdomen
• Bloody urine
• Stiff neck
• Seizures
• Heart attack
• Cold, painful hands and feet
• Painful tips of fingers or toes
• Nausea, vomiting, and abdominal pain

What Causes It?

Most causes of endocarditis are related to a bacterial or fungal infection. Your body can usually fight off an infection, even if bacteria reach your heart. However, when heart valves or tissues are damaged, they provide a good place for bacteria to lodge and multiply.

Your risk of endocarditis increases if you have:

• Heart disease or mechanical heart valves
• Poor dental hygiene
• Diabetes
• HIV
• Kidney disease
• Dental procedures that irritate the gums
• Tonsillectomy
• Adenoidectomy
• Intestinal and respiratory surgery
• Gallbladder surgery
• Cystoscopy
• Bronchoscopy
• Vaginal delivery with an infection present

What to Expect at Your Doctor's Office

Your doctor will listen to your heart and lungs, take your pulse, and check your eyes and skin. You will likely undergo several tests, including:

• Blood tests
• Urine analysis
• Echocardiogram
• Computed tomography (CT) scan
• Magnetic Resonance Imaging (MRI)
• Cinefluoroscopy (a motion-picture type heart scan)

Usually, your doctor will admit you to the hospital, possibly in intensive care, until your symptoms are under control.

Treatment Options

Your doctor will treat endocarditis with high doses of antibiotics, almost always intravenously. Sometimes, surgery is also required.

Drug Therapies

Endocarditis is usually treated with a combination of 2 to 3 antibiotics, such as penicillin, gentamicin, vancomycin, cefazolin, ceftriaxone, nafcillin, oxacillin, rifampin, and ampicillin. Treatment is determined by what type of bacteria is infecting your heart and generally takes 2 to 6 weeks. In patients with endocarditis, long-term daily use of aspirin does not reduce the risk of embolic events, but may be associated with a higher level of bleeding.

Complementary and Alternative Therapies

Endocarditis has serious consequences and requires aggressive medical treatment. Endocarditis should never be treated with alternative therapies alone. Inform all of your health care providers of any alternative medicine therapies or supplements you are using. If you are pregnant, or thinking of becoming pregnant, do not use any complementary and alternative therapies (CAM) therapies unless directed to do so by your physician.

Following these nutritional tips may help reduce symptoms:

• Eliminate suspected food allergens, such as dairy (milk, cheese, and ice cream), wheat (gluten), soy, corn, preservatives, and chemical food additives. Your provider may want to test you for food allergies.
• Eat foods high in B-vitamins and iron, such as whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables (such as dulse, kelp, and wakame).
• Eat antioxidant-rich foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
• Avoid refined foods, such as white breads, pastas, and sugar.
• Use healthy oils in the diet, such as olive oil or coconut oil.
• Reduce or eliminate trans fatty acids, found in commercially-baked goods, such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid alcohol and tobacco.
• Exercise lightly 5 days a week if your health care provider says you can.

You may address nutritional deficiencies with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
• Omega-3 fatty acids, such as fish oil, 1 to 2 capsules or 1 to 2 tbs. of oil daily, to help decrease inflammation and help with immunity. Omega-3 fatty acids may increase the effects of blood-thinning medications, such as warfarin (Coumadin). Speak with your physician.
• Vitamin C, as an antioxidant and for immune support.
• Alpha-lipoic acid, for antioxidant support. Can potentially interfere with some diabetes and cancer medications. Talk to your doctor.
• Magnesium citrate, for heart health. Make sure your doctor approves magnesium supplementation. Magnesium can potentially affect blood pressure and kidney function, among other problems, and can interact with many medications.
• Coenzyme Q10 (CoQ10), for heart protection. CoQ10 can affect blood pressure and may decrease the effectiveness of blood-thinning medicines, such as warfarin (Coumadin).
• Resveratrol (from red wine), to help decrease inflammation and for antioxidant effects.
• Lycopene, for antioxidant and blood pressure lowering activity. People with prostate cancer may wish to avoid lycopene. More research is needed.
• L-theanine, for stress and nervous system support.
• L-arginine, for blood vessel and immune support. Arginine may affect blood pressure and blood flow through organs and other tissues. Talk to your doctor.
• Probiotic supplement (containing Lactobacillus acidophilus), when needed for maintenance of gastrointestinal and immune health. Some acidophilus products may need refrigeration -- check labels carefully. People who are severely immune compromised, or who are taking immunosuppressive drugs, should speak with their physicians before taking probiotic supplements.

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to determine the safest and most effective botanical therapies before starting treatment. Always tell your provider about any herbs you may be taking. You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted.

• Reishi mushroom (Ganoderma lucidum), 150 to 300 mg, 2 to 3 times daily, for blood pressure support. You may also take a tincture of this mushroom extract, 30 to 60 drops, 2 to 3 times a day. Reishi can alter blood pressure and interact with many medications, including blood-thining medications. Talk to your provider.
• Garlic (Allium sativum), standardized extract, 400 mg, 2 to 3 times daily, for heart health. Garlic supplements may increase the effectiveness of certain blood-thinning medications, such as warfarin (Coumadin), and can interact with many medications, particularly some HIV medications and isoniazid (Nydrazid). Talk with your physician.

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies as a supplemental treatment for the symptoms of endocarditis, as long as the underlying infection has been appropriately treated. Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

• Aconite. If you fear death, have rapid heartbeat (tachycardia) with full, hard pounding pulse of sudden onset.
• Cactus grandiflorus. For endocarditis with mitral insufficiency. You may have a feeble, irregular pulse and feel a chest constriction.
• Digitalis. If you have an irregular pulse with a sensation as if your heart would stop if you moved.
• Spongia. If you have a sensation of the heart swelling.

Acupuncture may help improve immunity and strengthen heart function.

Following Up

In addition to monitoring your condition while you are in the hospital, your health care provider will order follow up procedures, such as blood tests, to determine how well the prescribed treatment is working.

Supporting Research

Anavekar NS. Aspirin and infective endocarditis: an ancient medicine used to fight an ancient disease-but does it work? J Infect. 2009;58(5):329-31.

Athan E, Chu VH, Tattevin P, et al. Clinical characteristics and outcome of infective endocarditis involving implantable cardiac devices. JAMA. 2012;307(16):1727-35.

Bennett JE, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2009.

Bope ET, Kellerman RD. Conn's Current Therapy 2010. 1st ed. Philadelphia, PA: Elsevier Saunders; 2009.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea -- a review. J Am Coll Nutr. 2006;25(2):79-99.

Chan KL, Tam J, Dumesnil JG, et al. Effect of long-term aspirin use on embolic events in infective endocarditis. Clin Infect Dis. 2008;46(1):37-41.

Duval X. Effect of early cerebral magnetic resonance imaging on clinical decisions in infective endocarditis: a prospective study. Ann Intern Med. 2010;152(8):497-504,W175.

Ferri F. Ferri's Clinical Advisor 2014. 1st ed. Philadelphia, PA: Elsevier Mosby; 2013.

Fernandez Guerrero ML, Gonzalez Lopez JJ, Goyenechea A, et al. Endocarditis caused by Stphylococcus aureus: A reappraisal of the epidemiologic, clinical, and pathologic manifestations with analysis of factors determining outcome. Medicine (Baltimore). 2009;88(1):1-22.

Habib G, Badano L, Tribouilloy C, et al. Recommendations for the practice of echocardiography in infective endocaridiolyg. Eur J Echocardiogr. 2010:11(2):202-19.

Hayes DD. New guidelines for preventing infective endocarditis. Nursing. 2007;37(8):22-3.

Kanafani Z.Daptomycin compared to standard therapy for the treatment of native valve endocarditis. Enferm Infecc Microbiol Clin. 2010;28(8):498-503.

Kebed KY, Bishu K, Al Adham RI, et al. Pregnancy and postpartum infective endocarditis: a systematic review. Mayo Clin Proc. 2014;89(8):1143-52.

Martin RP. Infectious endocarditis: still a menace. J Am Soc Echocardiogr. 2010;23(4):403-5.

Murakami T, Niwa K, Yoshinaga M, et al. Factors associated with surgery for active endocarditis in congenital heart disease. Int J Cardiol. 2012;157(1):59-62.

Murdoch DR, Corey GR, Hoen B, et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med. 2009;169(5):463-73.

Pallasch TJ. Perspectives on the 2007 AHA Endocarditis Prevention Guidelines. J Calif Dent Assoc. 2007;35(7):507-13.

Pierce D, Calkins B, Thornton K. Infectious Endocarditis: Diagnosis and Treatment. American Family Physician. 2012;85(10).

Shimokoawa T, Kasegawa H, Matsuyama S, et al. Long-term outcome of mitral valve repair for infective endocarditis. Ann Thorac Surg. 2009;88(3):733-9; discussion 739.

Syed FF, Millar BC, Prendergast BD. Molecular technology in context: a current review of diagnosis and management of infective endocarditis. Prog Cardiovasc Dis. 2007;50(3):181-97.

Walls G, McBride S, Raymond N, et al. Infective endocarditis in New Zealand: data from the International Collaboration on Endocarditis Prospective Cohort Study. N Z Med J. 2014;127(1391):38-51.

Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J. 2005;46(5):585-96.

Zapfe jun G. Clinical efficacy of crataegus extract WS 1442 in congestive heart failure NYHA class II. Phytomedicine. 2001;8:262-6.

Zhao D, Zhang B. Are valve repairs associated with better outcomes than replacements in patients with native active valve endocarditis? Interact Cardiovasc Thorac Surg. 2014;19(6):1036-9.