19 Most Common Symptoms Of Endocarditis You Should Never Ignore

Very few diseases are similar to endocarditis, but endocarditis can simulate many different conditions. That’s something doctors understand, and that’s why endocarditis is an integral part of exams in the early training at medical school.

The heart has various layers, and one of them is called endocardium. The endocardium is the inner layer that covers cardiac valves and internal cavities of the heart. Endocarditis is an inflammation of the endocardium, and it is usually the result of a bloodborne infection that reaches the heart and infects susceptible areas.

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The signs and symptoms of endocarditis include the following:

Fever

It is a common symptom in almost every case of infection. Endocarditis is often the result of an infectious process that releases cytokines to the bloodstream and starts an inflammatory reaction that increases body temperature. This is a natural way the body has to fight the invader pathogen, and it is regulated by the brain. Endocarditis often produces mild fever, and it rarely goes higher than 101°F.

Chills

When the inflammatory cytokines reach the heart, they are received and interpreted by the brain as an ongoing infection. The brain increases the temperature threshold in the body and gives a signal to the rest of the tissues in order to create and conserve more heat. Chills are involuntary muscle movements intended to increase body temperature as a result of brain signals.

Night sweats

Fever and chills often appear at night, and may be accompanied by night sweats. In some cases, they may be as severe as to drench patients in their own sweat. Night sweats due to infectious diseases such as endocarditis should be differentiated from other causes, including hot flashes in post-menopausal women.

Fatigue

Patients with endocarditis often report feeling overly tired for no apparent reason. This is known as fatigue, and it is different from other causes of exhaustion. Fatigue is triggered even after rest, and it is often prolonged in time, sometimes accompanied by muscle weakness and sensation of numbness and mental fog.

Shortness of breath

Patients with endocarditis may have different symptoms located in the chest, including shortness of breath. This symptom is prevalent when you are lying down because the heart is creating pressure against the lungs. Other symptoms include cough, which makes patients believe it is possibly cold or common influenza, and chest pain, which may alarm doctors and patients into thinking it is a myocardial infarction.

Malaise

It is a feeling of general discomfort that cannot be easily traced, either because it has multiple reasons, or because it is by itself another symptom of the disease. Patients with endocarditis often feel uneasy and may have different sources of pain, which gives them this sensation. This symptom is highly unspecific and may be caused by various infections, and even non-infectious diseases.

Headache

The majority of patients with endocarditis will also suffer from headaches. They have different causes, including the inflammatory process itself, which releases inflammatory mediators that reach the brain and the meninges. Other causes include a series of neurological consequences of endocarditis, including aseptic meningitis, an irritation of the outer linings of the brain that trigger pain. In some cases, it would be an actual infection in the meninges, usually triggered by pneumococci. Be careful with patients diagnosed with endocarditis if they have sudden and very severe headaches, because they may be a sign of a stroke.

Muscle and joint pain

Patients with endocarditis have a severe inflammatory process that extends to the muscles and articulations because there are circulating immune complexes causing various musculoskeletal abnormalities. They often report muscle pain (myalgia) and joint pain (arthralgia), which are commonly found in many viral and bacterial diseases, as well as arthritis and other non-infectious processes. Endocarditis may simulate rheumatic diseases, and since it is rare compared to their incidence, doctors may delay their diagnosis if they do not have a clear view of all of the symptoms. Thus, make sure you report all of your symptoms to your doctor, and make notes if you think that will help you remember.

Loss of appetite

One of the prevalent signs of infective endocarditis is loss of appetite. However, it is not simply a general distaste and refusal of food. It is a severe loss of appetite, clinically known as anorexia, which often leads to serious nutritional problems in the patient.

Unintentional weight loss

Severe anorexia in patients with infectious endocarditis leads to nutritional deficiencies, including vitamin B deficiency, calcium, iron, zinc deficiency, among others. This may lead to other conditions, including anemia and unintentional weight loss. As the name implies, it is unplanned weight loss that results from the significant reduction of food intake and the metabolic stress the body endures during infectious endocarditis.

Heart murmurs

They are very prevalent in patients with endocarditis, and up to 85% of patients have a heart murmur. However, many patients with heart murmurs already had them before endocarditis ensued, and having one predisposes patients to this disease. Heart murmurs are sounds made by the heart and its valves as the blood rushes in and out of its chambers. It may be common in patients with congenital heart diseases, and appears or becomes changed during infectious endocarditis due to inflammation and the mechanical changes in the inner linings of the heart.

Red spots in the skin

As a result of infectious endocarditis, a series of bactericidal antibodies are released to the bloodstream, and they have agglutinating properties that may trigger a series of reactions in the skin. Thus, we may see small red spots dispersed throughout the skin. They are signs of bleeding in the skin, and called petechial, and may confuse the diagnosis with blood coagulation problems and hemorrhagic viruses.

Roth’s spots in the retina

For the same reasons explained above, a series of hemorrhagic spots start appearing in the retina. They are called Roth’s spots, and they are similar to red petechial spots but have a white center. They are mostly found in patients with bacteremia (blood infection) as a complication of bacterial endocarditis. They may be present in other diseases and health conditions, including anemia, leukemia, and carbon monoxide poisoning.

Splinter hemorrhages under the nails

Another hemorrhagic manifestation is found in the nails as very small blood clots under the nail that run vertically and are commonly dismissed because they are not very noticeable. These hemorrhages are plum-coloured, but may change their coloration to become darker after a few days. While Roth’s spots are characteristic in infective endocarditis, splinter hemorrhages are frequent in many different conditions, and will not likely guide the diagnosis.

Osler’s nodes in the toes or fingers

These are similar to petechial spots because they are often red, and they are caused by the same immune complexes with agglutinating properties. However, Osler’s nodes are typically raised lesions found in the body, and they are usually larger than petechial lesions. They are caused by immune complexes that deposit and trigger inflammatory responses in the skin, generally in the palm of the hand and the sole of the feet. They are also found in systemic lupus erythematosus, but evaluating them may be very useful to diagnose infective endocarditis.

Clubbing of the fingers

Clubbing of the fingers or the nails is a deformity in which the nails become wider than the rest of the finger. It is also known as nail clubbing or digital clubbing and has 5 stages according to how severe it is. This sign is commonly found in ailments affecting the heart and the lungs, including lung cancer, cystic fibrosis, many cardiovascular diseases, and endocarditis.

Enlarged spleen

Enlargement of internal organs is very common in infectious diseases, and it is especially prevalent in the liver and the spleen. In infective endocarditis, splenomegaly (enlargement of the spleen) is more common and should be differentiated from cases of syphilis, mononucleosis, and many other infectious diseases.

Confusion

In many cases, neurological alterations are among the first signs and symptoms that something is happening. Studies show that in 76% of cases, neurologic sequelae were already present in patients before starting therapy, and that includes confusion, altered consciousness, and even amnesia.

Seizures and other neurological problems

Central nervous system complications are found in 30% of patients with endocarditis, and they can be one of the most dangerous features of the disease. Patients may have focal seizures due to embolism, and may also have generalized seizures, but they are more usually caused as a pharmacologic adverse effect or due to hypoxia and other systemic conditions. Other neurological problems that should be carefully addressed include stroke, intracranial hemorrhage, and infectious aneurysms.

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Infectious endocarditis is inevitably fatal if left untreated. It leads to severe insufficiency in the heart valves, heart failure, abscesses in the muscle layer of the heart, and severe neurologic consequences we have described in this article. Diagnosis requires fulfilling a series of diagnostic criteria and performing blood cultures and echocardiograms as a confirmatory test. Management is done with antibiotics depending on blood cultures, and sometimes empiric antibiotic therapy.