Endocarditis: symptoms, causes and treatment

The NHS lists the symptoms below. They sometimes appear quickly over a few days but often come on slowly over weeks or months, and may resemble an everyday illness, which is why the BHF says it can be tricky to spot.

• A high temperature, or feeling hot, cold or shivery.

• Headaches and feeling very tired.

• Joint or muscle pain.

• Regularly sweating a lot during the night (night sweats).

• Feeling breathless, loss of appetite or losing weight without trying.

• Small dark-coloured spots on the skin, or red spots on the palms or soles.

• Small dark spots or dark lines under the fingernails.

• Small painful lumps on the fingers or toes.

• Chest or back pain.

The British Heart Foundation describes endocarditis as inflammation of the inner lining of the heart, often damaging the heart valves, sometimes called infective or bacterial endocarditis. It happens when bacteria or fungi enter the bloodstream and attach to heart tissue. It is rare but very serious.

The NHS says anyone can get it, but it is more common in men and people over 50.

Endocarditis usually happens when bacteria or fungus gets into the blood through the mouth or skin and travels to the heart, for example during a dental procedure or through a cut or graze. The BHF says that if your heart is already damaged there is a higher risk, because it is easier for germs to settle and grow in damaged areas.

A doctor will examine you and listen to your chest and ask about recent dental treatment or other procedures. If they think you may have endocarditis you will usually be referred to a cardiologist. The NHS says tests check for bacteria or fungi, how your heart is working and any damage, and usually happen in hospital.

They may include blood and urine tests, a chest X-ray, an electrocardiogram and echocardiogram, and an MRI scan. The BHF says that because it is a serious infection, doctors might start treatment while confirming the diagnosis.

The NHS says treatment usually involves medicine and sometimes surgery. You will be given antibiotic or antifungal medicine for 4 to 6 weeks, usually in hospital through a drip or injections into a vein at first. If you feel well enough and tests show the infection is under control, you may be able to finish the IV medicine at home, and some people continue tablets for a few more weeks.

Around half of people who have endocarditis will need surgery to remove or repair damaged heart tissue or valves. Depending on where the infection is, you may also need a pacemaker fitted, or yours removed and replaced.

The NHS says many people fully recover, particularly if the infection is found and treated early, but it can take several months to feel completely better, especially after surgery, and it is normal to feel very tired for several weeks. You will need regular check-ups and blood tests.

Endocarditis can damage the heart and lead to heart failure, and having it increases the chance of a stroke. You also have a higher chance of getting endocarditis again, so it is important to know the symptoms and get help quickly.

If you are at higher risk, the NHS suggests taking care of your teeth and gums and having regular dental check-ups, speaking to a doctor before dental procedures, cleaning and covering cuts and grazes, washing your hands regularly, and making sure family and carers know the symptoms. It also says not to get piercings or tattoos without speaking to a doctor first.

Get help from NHS 111 if you have symptoms of endocarditis. Speak to your GP as soon as possible if you have been told you are at high risk and have any of the symptoms, and watch for flu-like symptoms with a high temperature.

Call 999 if you or someone with you has face weakness, weakness or numbness in one arm or down one side, speech problems, or blurred vision or loss of sight in one or both eyes. These can be signs of a stroke, which can be a complication of endocarditis.

Endocarditis is treated in hospital because of the IV antibiotics, scans and the need for cardiac assessment, so care is nearly always through NHS emergency or cardiology services. Private cardiologists can offer scans and follow-up; ask what is included.