Symptoms of Infective Endocarditis

The most common symptoms of Infective Endocarditis are:

• Febrile body temperature (38.5 – 39.5 degrees Celsius) – occurs in approximately 90% of the patients with infective endocarditis. It occurs as a result of toxins released by the bacteria. It is usually accompanied by aching joints and muscles, night sweats, chills and weight loss.
• Heart murmurs – present in 85% of the patients. Heart murmurs are unusual sounds which can be heard during a heartbeat. They usually occur as a result of acquired heart valve disease. The most commonly affected valve is the aortic valve, while mitral valve is affected somewhat less frequently.

The following symptoms can be seen in as many as 50% of the patients with Infective Endocarditis:

• Chest pain - characterized by the patients as dull and continuous.
• Palpitations – is an abnormal heartbeat which can be felt by the patient. This symptom is caused by the damage to the electrical conduction system of the heart by the inflammation process. This symptom, however, is not very stable – it can appear and disappear and change with time as the disease progresses. In the beginning it can manifest itself as tachycardia or bradycardia. In later stages of infective endocarditis, the patient may develop gallop rhythm (this rhythm includes three or four sounds rather than two). Gallop rhythm can be a sign of heart failure.
• Shortness of breath - The patient may have difficulty breathing as a result of left-sided heart failure which leads to pulmonary hypertension. Other symptoms caused by pulmonary hypertension may include dizziness, fainting, fatigue and non-productive cough.
• Yellowish tint of the skin – this is a very characteristic symptom associated with infective endocarditis. The skin of the patient gains a yellowish/brownish tint as the disease progresses.
• Petachiae – small red spots on the skin caused by broken capillary blood vessels. They occur as a result of the influence of bacterial toxins on the capillary blood vessels.
• Subungual hemorrhages – collection of blood under the toenails and fingernails. They occur for the same reason as petachiae.
• Osler’s nodes – small red nodes that appear on the hands and feet and are the result of hemorrhage caused by the ruptures of small vessels. These small hemorrhages often appear as well on the sclera of the eyes.
• Thickening of the distal parts of fingers - This causes the fingers to look like drumsticks and the nails to look like watch glass. This condition is often referred to as nail clubbing. It is believed that this symptom is caused by the hypoxia in the distal parts of the body since the heart is unable to provide sufficient pumping action. This hypoxia triggers the proliferation of collagen and leads to the enlargement of the tissues having poor blood flow.

Moreover, infective endocarditis can often result in the formation of mural thrombi (blood clots that adhere to the wall of the heart). These blood clots can often be dislodged and cause an embolism of an artery either in the pulmonary circuit or in the systemic circuit. This can cause a number of complications including:

• Embolic stroke – an ischemic (caused by the lack of blood) stroke caused by a blood clot, which leads to focal neurologic deficits. This can result in aphasia, hemiparesis, paralysis, and a number of other neurologic symptoms.
• Multiple microabscesses – occur when tiny blood clots that form within the heart get dislodged and obstruct the blood flow in various organs and tissues, causing necrosis as a result of hypoxia. These microabscesses often occur in kidneys and liver resulting in renal and liver failure.
• Pulmonary embolism – occurs when the blood clots that are formed within the right side of the heart, become dislodged and embolize the main artery of the lung or its branches. The symptoms of this condition include difficulty breathing, chest pain, rapid breathing and heart rate. In severe cases, this condition can lead to collapse (sudden drop in blood pressure) and sudden death. This condition can also lead to pulmonary infarction – necrosis of a part of a lung. 

Next Chapter: Diagnosis of Endocarditis