Endocarditis is a bacterial or fungal infection that affects the heart valves and sometimes the inner lining of the heart chambers. Although it is an uncommon heart condition, it can have very serious consequences when it does occur.

Bacterial endocarditis occurs when bacteria enters the bloodstream, multiplies, and causes an infection in the heart. These bacteria can get into the bloodstream through a variety of methods, including dental and medical procedures and especially during surgery in other areas of the body.

Any person can develop this condition, but patients with damaged heart valves are at greater risk. Bacteria have great difficulty attaching to the smooth lining of normal heart valves. Damaged valves, however, have rough surfaces that bacteria stick to more easily. After attaching to the lining of the valves, these bacteria multiply and develop an infection. It is important to treat endocarditis as soon as possible. Left untreated, this infection can lead to heart failure, stroke and infections in other parts of the body.

Cardiovascular specialists at the Brigham and Women’s Hospital (BWH) Heart & Vascular Center offer comprehensive inpatient and outpatient clinical services to adults with endocarditis, from diagnosis to innovative surgical valve repair and replacement therapies.

Endocarditis Topics

Risk Factors for Endocarditis

Patients with damaged heart valves or a heart valve replacement are at greater risk for developing endocarditis. There are a number of ways that bacteria can get into the bloodstream and cause an infection in these patients’ valves, including:

  • Dental procedures, including teeth cleaning
  • Tonsillectomy or adenoidectomy
  • As a result of certain types of procedures involving the respiratory passageways, the gastrointestinal tract (colonoscopy), or the urinary tract
  • Gall bladder or prostate surgery
  • Catheters or needles
  • Skin sore or gum disease

Endocarditis can also affect people who have:

Symptoms of Endocarditis

Endocarditis symptoms, which may develop slowly or suddenly, include:

  • Fever, chills, and sweating (occurs in most cases)
  • Weakness and fatigue
  • Shortness of breath
  • Joint and muscle pain
  • Swelling in the feet, legs, or abdomen
  • Splinter hemorrhages - small areas of bleeding under the fingernails or toenails
  • Janeway lesions - red, painless spots on the palms of the hands and soles of the feet
  • Osler’s nodes – red, painful areas in the finger pads and toe pads
  • Petechiae – tiny red or purple spots (caused by bleeding) in the whites of the eyes
Diagnosis of Endocarditis

At Brigham and Women’s Hospital, our cardiovascular specialists provide expert evaluation and diagnosis with the aid of the latest in advanced imaging technologies. Along with performing a careful physical examination, your cardiologist may order one or more of the following imaging or lab tests:

Treatment for Endocarditis

Our cardiovascular specialists develop individualized treatment plans for patients based on:

  • Age
  • Overall health
  • Medical history
  • Severity and form of the disease
  • Tolerance for specific medications or procedures
  • Expectations for course of the disease
  • Presence of other conditions

Treatment may include:


  • Antibiotics. In most cases, you will first be treated with appropriate antibiotics to gain control of the infection before damage occurs. After the appropriate antibiotic is determined high dose therapy (often intravenously) will be administered over the course of several weeks.


If the antibiotic therapy fails to control the infection before severe valve damage occurs or the infection leads to embolization, surgery likely will be recommended. If valve damage is limited to the leaflets (flaps of tissue covering the valve openings) or the infection has spread into the heart, the following will be recommended:

What You Can Expect

The Heart & Vascular Center is located in the Shapiro Cardiovascular Center, across the street from BWH’s main 75 Francis Street entrance. The Heart & Vascular Center brings together the full range of services in one location, fostering seamless and coordinated care for all cardiovascular patients.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Watkins Clinic for pre-operative information and tests.

The day of surgery, you care will be provided by surgeons, anesthesiologists and nurses who specialize in surgery for patients with endocarditis. After surgery, you will go to the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.

During your surgery, family and friends can wait in the Shapiro Family Center. Staff members will provide surgery updates and caregivers who leave the hospital will be contacted by cell phone.

Download Cardiac Surgery: A Guide for Patients

Multidisciplinary Care

Patients benefit from the teamwork of medical cardiologists, interventional cardiologists, cardiac surgeons, cardiovascular imaging experts and radiologists, and anesthesiologists, all experts in endocarditis. They work alongside nurses, physician assistants, physical therapists, dietitians and social workers to achieve outstanding outcomes for our patients.


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