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Most people who develop infective endocarditis have an underlying heart valve disorder, such as mitral valve prolapse (see page 591) or congenital (present at birth) lesions of the heart valves. Heart valve replacement surgery (see page 590) can sometimes lead to infective endocarditis. Bacteria also can enter the bloodstream during minor surgery, tooth extractions, teeth cleaning, endoscopy (an examination of the inside of the body using a viewing instrument), or by injecting illicit drugs with contaminated syringes or needles. To prevent infective endocarditis, people who have heart disease need to take antibiotics immediately before surgery or dental treatment or promptly after any skin infections develop. This precaution helps destroy any bacteria that might otherwise enter the bloodstream and cause infective endocarditis.

Symptoms

A person with infective endocarditis usually has a fever of less than 102°F. Other possible symptoms include sudden chills (especially after the bacteria have spread through the bloodstream), headaches, aching joints, fatigue, and loss of appetite. If the heart valves are affected, symptoms of heart failure (see page 570) may occur eventually.

If blood clots form, symptoms depend on their location. For example, if clots form in the hands or feet, you may have painful lumps in the tips of your fingers or toes, or small bruises behind your nails. A clot that lodges in the brain can cause a stroke (see page 669). Clots from bacterial endocarditis can lodge anywhere in the body, sometimes causing small abscesses (pus-filled cavities surrounded by inflamed tissue) to form. Bacterial endocarditis can also cause anemia or kidney disease, both of which usually clear up after the infection is treated successfully. If you have any of the symptoms described above, see your doctor as soon as possible.

Diagnosis

Because the symptoms of infective endocarditis can be caused by a number of diseases and conditions, tell your doctor if you have had a heart valve disorder or a heart murmur, or any of the symptoms described above.

If your doctor thinks you may have infective endocarditis, he or she will admit you to a hospital and will order blood tests to identify the type of microorganism that is causing the infection. You will also have a Doppler ultrasound scan (see page 111) to help determine the location and severity of damage to the valve.

Treatment

To treat infective endocarditis, a doctor will prescribe an antibiotic to fight the microorganism that is causing the infection. If bacterial endocarditis is diagnosed and treated effectively within 6 weeks of infection, there is a 90 percent chance of eliminating the infection. Long-term effects depend on the valve that is damaged and the severity of the damage.

Pulmonary Hypertension

Pulmonary hypertension is elevated blood pressure in the lungs. The disorder can result from any disease that blocks the flow of blood or oxygen through the lungs, such as congenital (present at birth) heart disease (see page 389), chronic bronchitis (see page 655), and emphysema (see page 656). People who live for many years at high altitudes have an increased risk of pulmonary hypertension. Whatever the cause, the main result is increased pressure inside the pulmonary arteries. Over time, this pressure leads to thickening of the arteries, which obstructs blood flow. In an attempt to compensate for poor circulation, the right side of the heart becomes enlarged. The increased workload can eventually cause heart failure (see page 570). Women are five times more likely than men to develop pulmonary hypertension.

Symptoms

Pulmonary hypertension often causes no symptoms until the condition is advanced, when the main symptom is swollen ankles. Your skin may have a bluish tinge because your blood does not contain enough oxygen. The low oxygen content of the blood stimulates the production of more red blood cells, a condition called polycythemia (see page 627). As the number of red cells increases, the blood