Endocarditis is an infection that occurs in the lining or valves of the heart. The infections are most often bacterial, but they can also be viral or fungal. Some medical conditions that cause the blood to clot too easily may cause a noninfectious form of endocarditis.
Bacterial infections are the most common cause of endocarditis in children. When bacteria get into the bloodstream they flow through the body and eventually into the heart. In a healthy heart the inner lining and valves are smooth, and it is very rare for the bacteria to find a place to lodge. In a heart that has been damaged, the lining and/or valves may have rough areas; it is here that the bacteria find a place to lodge and grow, ultimately infecting and damaging the heart, even causing harm that can't be repaired, leading to heart failure.
- According to the American Heart Association (AHA), there are many ways that bacteria can get into the heart, some of the most common being:
- Dental procedures (including teeth cleaning)
- Tonsillectomy or adenoidectomy (surgical removal of tonsils or adenoids)
- Rigid bronchoscope exam of the respiratory passageways
- Certain types of surgery on the respiratory passageways, gastrointestinal tract or urinary tract
- Gallbladder or prostate surgery
Children born with certain congenital heart conditions or who have chronic heart disease are at a higher risk for endocarditis. In addition, once a child has had endocarditis he or she may be more susceptible to getting it again. Some conditions that increase a child's risk of endocarditis include:
- An artificial (prosthetic) heart valve
- History of rheumatic disease or collagen vascular disease, especially if there are damaged heart valves
- Complex cyanotic congenital heart disease due to insufficient oxygen in the blood
- Pulmonary hypertension
- Pulmonary shunts or conduits
- Patent ductus arteriosus, ventricular septal defect, coarctation of the aorta, bicuspid aortic valve
- Enlarged heart
- Mitral valve prolapse
- Hypertrophic cardiomyopathy, and enlarged heart muscle that causes impeded blood flow
- Weakness, low energy
- Sweatiness, night sweats
- Shortness of breath
- Loss of appetite, weight loss
- Chest pain
- Abdominal pain
- Nausea and vomiting
- Painful red bumps on the fingers and toes
- Purple dots on the whites of the eyes, under the fingernails and over the collarbone
- Painful red patches on the fingers, palms and soles
- Unexplained rashes
If your pediatrician suspects that your child may have endocarditis, your child will need further evaluation to determine the cause and extent of the infection. This will help to determine the proper course of treatment. When you visit the pediatric cardiologist, a medical history of your child will be taken, along with a thorough physical exam. The doctor will listen for any heart rhythm abnormalities, such as a heart murmur. Because the bacteria that lead to endocarditis usually enter through the bloodstream, blood tests will be needed, including a complete blood count (CBC) and a blood culture to determine the specific type of bacteria in the bloodstream. An echocardiogram, or echo, will be performed as well. This is a painless, noninvasive procedure that uses sound waves to create a moving picture of your child's heart and heart valves. This will enable the pediatric cardiology team to evaluate the structure and function of your child's heart and determine where the infection is and how extensive it is.
Endocarditis is a very serious condition. It can can cause severe damage to the lining and valves of the heart. Because most cases of pediatric endocarditis are bacterial infections, your child may be given strong antibiotics through an IV over several weeks. If heart damage has already occurred or if the endocarditis is caused by a viral or fungal infection, or has a noninfectious cause, other treatment protocols may be needed. Choosing the right treatment for your child is critical and depends on many things:
- Your child's age
- Medical history
- Cause of the infection
- Extent of the infection (the earlier it is diagnosed, the better)
- The course of the infection
- What medications, procedures and therapies your child is able to tolerate
All of these criteria will determine which options are best suited to your child's care. As part of the team, and as the parent, you will be a part of the decision making process, choosing a treatment plan that works best for your child and your family.
One of the first steps to preventing endocarditis is teaching your child the importance of good dental hygiene. This is especially true if your child has a high risk for this type of infection. Your child should practice regular brushing (every morning, after meals and before bed) and daily flossing. Regular visits to the dentist for cleanings and tooth care are critical.
Your pediatric cardiologist may have your child take an antibiotic before any kind of procedure, including dental, surgical and some types of testing. This is usually a single dose taken once just prior to the procedure. Not all children will be treated with an antibiotic. Based on the guidelines set by the Infectious Diseases Society of America, the Pediatric Infections Disease Society and the American Dental Association, only those children with cardiac complications at the highest risk for complications from endocarditis should be prescribed pretreatment antibiotics. This includes:
- Artificial (prosthetic) heart valves
- History of endocarditis
- Unrepaired cyanotic congenital conditions, including palliative shunts and conduits
- Congenital heart conditions that have been completely repaired with prosthetic material or device, placed by either surgery or catheter intervention, during the first six months following the procedure
- Repaired congenital heart conditions with residual defects at or next to the site of a prosthetic patch or device
- Heart transplant recipients, especially those with heart valve disease
Your pediatric cardiologist will discuss preventive care with you and answer any questions and concerns you may have.
Rare and complex congenital heart defects don’t always present a clear cut method of treatment. Often, there are multiple ways of approaching the diagnosis. Our physicians also are available to provide second opinions for families seeking alternative treatment options. If you would like to schedule an appointment, refer a patient or speak to our staff, please call our offices at 682-885-2140.