Endocarditis

Learn About Our Heart Center

Schedule an Appointment

What is endocarditis?

Endocarditis (pronounced en-doh-car-DIE-tis) is an infection of the lining inside the heart. This lining is called the endocardium.

Bacterial infection is the most common source of endocarditis. Infection happens when bacteria enter your child’s blood, attach to the inside of their heart and multiply. This can damage or even destroy the heart valves.

Bacterial endocarditis is always a serious infection.

Who gets endocarditis?

Most hearts have a smooth lining that is difficult for bacteria to stick to. Congenital heart disease sometimes causes rough areas on the lining or other changes that make it easier for bacteria to stick. If bacteria stick, they can survive and multiply.

Endocarditis is uncommon. It is more likely to happen in children after heart surgery. This includes children who were born with heart defects or who have damaged heart valves, artificial heart valves or devices implanted in their heart or blood vessels.

It is extremely rare, but possible, for children without heart defects to get endocarditis.

Symptoms of Endocarditis

The symptoms of endocarditis can vary based on the bacteria that caused the infection and how severe it is. Your child’s symptoms may also depend on whether they already had a heart problem before getting the infection.

Many symptoms of endocarditis are like other illnesses, such as the flu, but usually last longer than the flu.

Endocarditis in children may cause 1 or more of these symptoms:

Fever that lasts for more than 5 days (or even weeks) or comes back often
Extreme tiredness
Decreased appetite
Muscle aches
Achy joints

Endocarditis can lead to other problems in the body. It can damage heart valves and cause heart failure.

Clumps of bacteria and other cells can break off from the infected part of the heart and travel through the blood. This can lead to infection in another part of the body or block blood flow through a blood vessel. These complications can cause symptoms of their own and can be serious.

Heart Center at Seattle Children's

Our pediatric cardiologists and cardiac surgeons have more advanced training and experience operating and performing procedures on babies, children and teens than at any other children's hospital in the Pacific Northwest.

Diagnosing Endocarditis

To diagnose this condition, your child’s doctor will examine your child for signs of heart injury from infection or signs that clumps of bacteria are coming out of the heart.

The doctor will ask for details about any symptoms your child has, their health history and your family health history.

Two tests are almost always used together to diagnose endocarditis. One is called blood cultures, and the other is called an echocardiogram.

Blood cultures

Blood cultures are tests used to find bacteria. Finding the exact type of bacteria lets us design the best treatment. To get blood samples, your child will need 2 to 3 needle pokes into a vein. Sometimes, we will need to insert a small tube (catheter) into a vein to collect the blood. We cannot use blood from a heelstick or fingerstick because bacteria on the skin will contaminate the sample.
Echocardiogram

Echocardiogram (usually called an “echo”) is a test that cardiologists use to look at the inside of the heart. We can use it to look for signs of bacteria growing. One important sign is a clump of bacteria and cells stuck to the lining of the heart or valves (called a vegetation). Echos can also show if a heart valve has been injured.
More imaging options
If needed, we have more imaging options to get a better view. These include:
- PET/CT (positron emission tomography/computed tomography)
- Cardiac MRI (magnetic resonance imaging)
- Transesophageal echocardiography

Treating Endocarditis

This infection is usually treated with strong antibiotics — medicines that fight bacteria.

Your child might need to stay in the hospital for a while and get antibiotics through a vein (intravenously, or by IV). This treatment usually lasts 4 or 6 weeks.

If IV antibiotics are working well, your child may be able to finish IV treatment at home. In this case, an interventional radiologist places a PICC (peripherally inserted central catheter) line in your child’s arm before your child leaves the hospital. A nurse teaches you how to take care of the line.

In rare cases, the infection does not respond well enough to antibiotics or valve damage is severe. If this happens, your child may need surgery to clean out the infection or repair or replace the valve. Seattle Children’s cardiologists and heart surgeons work together closely to care for children who need surgery.

Preventing Endocarditis

Certain people are at risk for endocarditis. These include children who:

Were born with heart defects
Have mechanical heart valves
Have untreated heart disease that causes cyanosis, like tetralogy of Fallot
Had heart surgery in the past 6 months
Had endocarditis before
Had a heart transplant

Talk with your child’s doctor about whether your child needs to take any special steps to prevent infection.

Take special care of your child’s mouth and teeth

The mouth is 1 of the most common sources of bacteria that cause endocarditis. Taking good care of the teeth and gums is the most important step everyone can take to prevent endocarditis.

Children at the highest risk for endocarditis need to take antibiotics before having dental work. Your child’s Heart Center team can explain if your child needs this. If you’re not sure, ask your child’s doctor.
Watch for fever and illness

If you know your child is at risk, they should see the doctor if they get a sudden high fever or they have a low-grade fever and tiredness for more than 5 days.

The best way to prevent complications from endocarditis is to get the diagnosis as early as possible. This way your child can start treatment before the infection causes serious damage to the heart.

Endocarditis at Seattle Children’s

The experts you need are here
- Our team of more than 40 pediatric cardiologists has experience diagnosing and treating every kind of heart problem. Our surgical outcomes are among the best in the nation year after year.
- We have a great deal of experience with the treatment your child may need, including medicines and heart valve repair. Seattle Children’s infectious disease specialists help to choose the best therapy for the infection. They remain part of your child’s team until the infection is fully treated.
- We have heart surgeons, a pediatric cardiac anesthesia team and a specialized Cardiac Intensive Care Unit in the rare case your child needs surgery or intensive care during their illness.
“Casey’s team brought us into the fold, including us in rounding conversations about his care and ensuring we understood everything that was happening. …. I can’t stress enough how the combination of clinical expertise and compassion that we experienced at Seattle Children’s made all the difference.”

– Ed Lang, whose son Casey made a remarkable recovery after treatment at Seattle Children’s for an infection that affected his heart
Care from birth through young adulthood
- If your child is at risk for endocarditis, we make sure you know the best ways to reduce their risk and prevent problems throughout their life.
- Seattle Children’s cardiologists see babies, children and teens with endocarditis. We have experience treating kids of all ages to clear their infection and repair heart damage, if they have any.
- For children with heart damage, we create a custom treatment plan. As your child grows, we closely check their needs to make sure they get the care that is right for them at every age.
Support for your whole family
- We are committed to your child’s overall health and well-being and to helping your child live a full and active life.
- Whatever types of care your child needs, we will help your family through this experience. We will discuss your child’s condition and treatment options in ways you understand and involve you in every decision.
- Our Child Life specialists know how to help children understand their illnesses and treatments in ways that make sense for their age.
- Seattle Children’s has many resources, from financial to spiritual, to support your child and your family and make the journey as smooth as possible.
- Many children and families travel to Seattle Children’s for heart surgery or other care. We help you coordinate travel and housing so you can stay focused on your child.
- Read more about the supportive care we offer.