“My 27-year-old patient was on a ventilator in intensive care. No one expected her to survive,” says Gösta Pettersson, MD, PhD, Vice Chairman of Thoracic and Cardiovascular Surgery at Cleveland Clinic. “She had endocarditis — caused by years of drug abuse.”
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Endocarditis is an infection that “devours” the heart muscle. It comes from common bacteria, which you have in your mouth, on your skin and throughout your body. However, if those bacteria enter your bloodstream, they can stick to and attack your heart’s valves or inner lining (endocardium) and become deadly.
Who is at risk?
Healthy hearts usually can resist the infection. But if a heart is damaged, bacteria can attach and grow on the damaged area. People most at risk for endocarditis are those who have:
Intravenous drug users also are at high risk for developing endocarditis. Dr. Pettersson’s patient, Lisa (not her real name), had begun taking drugs at age 16, after surgery for a back injury. Using pain medication turned into years of abusing pain medication — and eventually heroin.
Signs of endocarditis
One day, Lisa began to feel sick, like she had the flu. It was hard to get out of bed. She was tired and weak, and had intense chest pain that made breathing difficult.
The symptoms, however, weren’t from the flu. They were signs of endocarditis, which also can include:
- Fever over 100 degrees
- Night sweats
- Skin rash
- Pain, tenderness, redness or swelling
- Wound or cut that won’t heal
- Red, warm or draining sore
- Sore or scratchy throat
- Sinus drainage, nasal congestion, headaches or tenderness along upper cheekbones
- Persistent cough
- White patches in your mouth or on your tongue
- Nausea, vomiting or diarrhea
Getting the right treatment
A relative found Lisa unconscious and rushed her to the hospital, where she was diagnosed with endocarditis. Diagnosis requires a physical exam, blood test and an echocardiogram.
“She couldn’t speak, but I knew she could hear me,” says Dr. Pettersson. “I told her how serious her condition was and that she was lucky to be alive. I also told her I would do everything I could to help her, but she had to stay off drugs.”
In addition to stopping drugs and going through rehabilitation, Lisa’s treatment included:
- Intravenous (IV) antibiotics. Patients have antibiotics for up to six weeks. Sometimes it’s enough to beat the infection.
- Surgery. When the infection is severe or when there is heart damage, a surgeon will cut out the infected and destroyed tissue and repair or replace affected heart valves and tissue.
- Ongoing preventive antibiotics. To stop endocarditis from recurring, some people take preventive antibiotics throughout life, particularly before dental work or other surgical procedures.
How to prevent recurrence
As of this writing, Lisa has been clean for seven months. She now has a sponsor, is attending Alcoholics Anonymous meetings and is in college, studying criminal justice. She wants to help others like herself, she says.
“My patient’s drug addiction will be a lifelong battle — but ‘so worth living to fight it,’ she tells me,” says Dr. Pettersson. “Endocarditis can be a lifelong concern as well. But with the right treatment, recurrence is unlikely.”
If you have signs of endocarditis — especially if you have compromised heart valves or other heart disease — see a doctor immediately. Quick treatment may help you avoid heart surgery and even save your life.
Questions and Answers About Endocarditis (video by Gösta Pettersson, MD, PhD)
Surgery for Infective Endocarditis