What is endocarditis?
Endocarditis is an infection of the inner lining of the heart chambers and valves, most commonly caused by bacteria entering the bloodstream. It can damage or destroy heart valves, requiring emergency surgery in 25-50% of cases. Patients with prosthetic heart valves, prior endocarditis, certain congenital heart defects, or IV drug use are at highest risk. Endocarditis carries a 15-30% in-hospital mortality rate.
The complete answer.
Endocarditis typically presents with fever, malaise, new or changing heart murmur, and embolic phenomena (stroke, splenic infarcts, skin lesions). Diagnosis requires blood cultures and echocardiography (TEE is more sensitive than TTE). Treatment involves prolonged IV antibiotics (4-6 weeks), and surgery is needed for large vegetations, valve destruction, heart failure, abscess formation, or persistent infection. The 2023 ACC/AHA guidelines expanded the indications for early surgery in endocarditis. Antibiotic prophylaxis before dental procedures is recommended for high-risk patients.
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