Endocarditis During Pregnancy

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Endocarditis is inflammation in the endocardium­–the inner lining of your heart and heart valves. Endocarditis usually occurs from an infection of bacteria, fungi, or viruses that spreads from your blood stream to your heart. If not treated promptly, endocarditis can permanently damage your heart and lead to life-threatening complications.

Risks during pregnancy

The risk of endocarditis in pregnancy is low (less than 1 per 10,000 women). However, as many as one-third of women who develop endocarditis die from heart failure or an embolism related to the infection. Nearly the same portion of fetuses are lost from complications of maternal endocarditis.

Your risk for endocarditis increases if you have pre-existing heart damage, artificial heart valves, or a heart defect. In pregnancy, endocarditis tends to occur more often in the third trimester than in the earlier stages of pregnancy. You are also at risk for endocarditis if you have had endocarditis before or if you have ever used illegal intravenous drugs.

Other activities pose a risk of causing serious infections that have been linked to endocarditis:

  • Poor oral health or dental procedures that can cut your gums (anything that may cause your gums to bleed and allow bacteria from your mouth to enter your blood stream)
  • Any infection, including skin infections, gum disease, and inflammatory bowel disease
  • Use of catheters
  • Use of needles for tattooing or piercing

 Symptoms of endocarditis

Endocarditis may cause the following symptoms:

  • Flu-like symptoms such as fever and chills
  • New or changed heart murmur
  • Fatigue
  • Aching joints and muscles
  • Night sweats
  • Shortness of breath
  • Chest pain while breathing
  • Swelling of your feet, legs, or abdomen

Less common symptoms include:

  • Unexplained weight loss
  • Blood in your urine
  • Tenderness in your spleen (just below your ribs on the left side of your body)
  • Red spots on the palms of your hands and soles of your feet
  • Tiny purple or red spots on the skin, whites of your eyes, or inside your mouth (called petechiae)

Unfortunately, some of these symptoms are similar to normal pregnancy-related symptoms. If the symptoms are severe or have a sudden onset, they may be related to a more serious condition and you should contact your doctor.

Complications of endocarditis

If left untreated, endocarditis can permanently damage the tissue of your heart and heart valves. The infection-causing organism can form small clumps that can break loose like a blood clot and block blood flow to other organs.

Major complications of endocarditis include:

  • Heart valve damage
  • Heart failure
  • Stroke
  • Seizure
  • Paralysis
  • Abscesses (pockets of pus) in organs around your body
  • Pulmonary embolism
  • Kidney damage
  • Enlarged spleen

Treatment of endocarditis

The treatment of endocarditis usually involves antibiotics to treat the causative infection, but surgery may be required in some cases, though this is generally not recommended during the first 2 trimesters of pregnancy except in extreme emergencies. Depending on how far along your pregnancy is, early delivery may be appropriate.

Prevention of endocarditis

Practice good oral hygiene and keep your teeth and gums healthy and do not undergo procedures that may increase your risk of infection, such as tattoos or piercings, during pregnancy.

Occasionally, antibiotics may be given before procedures with a high risk of infection, such as dental surgery. If you are at increased risk for endocarditis, talk to your doctor or dentist before any surgery or procedures; taking antibiotics before the procedure may decrease your risk of developing an infection. If you think you have any symptoms of endocarditis, seek medical care immediately.

Jennifer Gibson
Dr. Jennifer Gibson earned a Bachelor of Science degree in Biochemistry from Clemson University and a Doctor of Pharmacy degree from the Medical College of Virginia School of Pharmacy at Virginia Commonwealth University. She trained as a hospital pharmacist and is the author of clinical textbooks, peer-reviewed journal articles, and continuing education programs for the medical community, as well as a contributor to award-winning healthcare blogs and websites. In her free time, she enjoys running, reading, traveling, and spending time with her family.

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