Introduction

Endocarditis is an inflammation of the endocardium, the inner lining of the heart and heart valves. Most cases are caused by a bacterial infection. Endocarditis is a serious ailment that can lead to severe medical complications, and can even be fatal if not treated.

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:

• Fever
• 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

What Causes It?

Most causes of endocarditis are related to a bacterial infection. Usually your body fights off an infection, even if bacteria reach your heart. But when heart valves or tissue 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. Procedures that increase your risk of endocarditis include dental procedures that irritate the gums, tonsillectomy, adenoidectomy, intestinal and respiratory surgery, gallbladder surgery, cystoscopy, bronchoscopy, and vaginal delivery with an infection present.

What to Expect at Your Provider's Office

Your health care provider will listen to your heart and lungs, take your pulse, and check your eyes and skin. They likely will order several tests, which could include blood tests, urine analysis, an echocardiogram, a computed tomography (CT) scan, a Magnetic Resonance Imaging (MRI) and a cinefluoroscopy (a motion-picture type heart scan). Usually, your provider will admit you to the hospital, possibly in intensive care, until your symptoms are under control.

Treatment Options

Your health care provider 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 two or three 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 - 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 ramifications and requires aggressive medical treatment. Alternative therapies may be used concurrently to help reduce severity, duration, and progression of disease, but 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.

Nutrition

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 health care 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.
• Eat antioxidant 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.
• Eat fewer red meats and more lean meats, cold water fish, tofu (soy, if no allergy), or beans for protein.
• Use healthy oils in the diet, such as olive oil or vegetable 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, if possible, 5 days a week.

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 - 2 capsules or 1 - 2 tbs. of oil daily, to help decrease inflammation and help with immunity. Omega-3 fatty acids can increase the effects of blood thinning medications such as Coumadin. Speak with your physician.
• Vitamin C, 500 - 1,000 mg daily, as an antioxidant and for immune support.
• Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support.
• Magnesium citrate, 200 - 400 mg daily, for heart health.
• Coenzyme Q10 (CoQ10), 100 mg twice a day, for heart protection.
• Resveratrol (from red wine), 50 - 200 mg daily, to help decrease inflammation and for antioxidant effects.
• Lycopene, 5 mg 1 - 3 times daily, for antioxidant and blood pressure lowering activity.
• L-theanine, 200 mg 1 - 3 times daily, for stress and nervous system support.
• L-arginine, 1 -2 gm 3 times daily, for blood vessel and immune support.
• Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, when needed for maintenance of gastrointestinal and immune health. Some acidophilus products may need refrigeration -- check labels carefully.
• Grapefruit seed extract (Citrus paradisi), 100 mg capsule or 5 - 10 drops (in favorite beverage) 3 times daily when needed, for antibacterial, antifungal, and antiviral activity, and for immunity.

Herbs

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 any treatment. You may use herbs as dried extracts (capsules, powders, 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 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

• Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant and heart health effects. Use caffeine free products. You may also prepare teas from the leaf of this herb. Green tea contains a small measure of vitamin K which may interfere with the action of some blood thinning medications such as Coumadin.
• Reishi mushroom (Ganoderma lucidum), 150 - 300 mg 2 - 3 times daily, for blood pressure support. You may also take a tincture of this mushroom extract, 30 - 60 drops 2 - 3 times a day.
• Garlic (Allium sativum), standardized extract, 400 mg 2 - 3 times daily, for heart health. Garlic supplements may increase the effectiveness of certain blood thinning medications such as Coumadin; speak with your physician.

Homeopathy

Although very 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 -- 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 bounding 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

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

Bope. Conn's Current Therapy 2010, 1st ed. Philadelphia, PA: Saunders, An Imprint of Elsevier; 2009.

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

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

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.

Conn. Conn's Current Therapy, 2010, 1st ed. Philadelphia, PA: Saunders, An Imprint of Elsevier; 2009.

Fernandez Guerrero ML, Gonzalez Lopez JJ, Goyenechea A, Fraile J, de Gorgolas M. 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.

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

Mandell. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 7th ed. Philadelphia, PA: Churchill Livingstone, An Imprint of Elsevier; 2009.

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.

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.

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.

Alternative Names

Heart infection - endocarditis