Endocarditis, an infection of the valves and inner lining of the heart, is connected to heart disease and heart valve disease and is a growing source of illness and hospitalization for seniors. And like many conditions that affect seniors, the symptoms are subtle and often mistaken for other age-related problems, leading to mis-diagnosis or no diagnosis at all. Twice as many men as women develop endocarditis, and fully 25% of cases are found in those over 60. Even healthy hearts can contract endocarditis if the lining of the heart is rough enough that germs can attach to it. Caregivers, home care aides and loved ones need to know the signs and symptoms of endocarditis.

In pre-WWII America, endocarditis was a fatal disease, since antibiotics had only recently been discovered and were not yet used widely. Caused most often by streptococcal or staphylococcal bacteria invading the endocardium, which is the inner lining of the heart chambers and heart valves, antibiotics routinely handle this infection. Doctors even prescribe antibiotics preventatively for situations like dental work where these germs are likely to enter the bloodstream. Strep throat and scarlet fever, which are typically childhood diseases, can lead to rheumatic fever when treated poorly or not at all, and rheumatic fever can cause heart damage after just one bout. Since rheumatic fever is less common today in developed countries, younger patients are avoiding the pre-conditions of endocarditis that plagued previous generations. However, improved treatments for common heart conditions have become more effective and successful. Heart surgery, pacemakers, valve replacements, and similar procedures that seniors receive regularly all leave the kind of scar tissue that snags germs in the bloodstream and causes infection. This creates a larger pool of seniors in the at-risk category, whose life expectancy increased along with the risk of developing an infection in the heart.

When bacteria, fungi or other germs not ‘native’ to the heart enter the bloodstream, they can attach themselves to damaged areas in the heart and start an infection. The immune system usually protects the heart by attacking the germs coming through in the bloodstream, but germs from the mouth, the throat, the skin and especially the gut can be very dangerous to the heart. These bacteria and fungi can enter the bloodstream relatively easily, through:

  • Brushing teeth or having dental work done in an unhealthy mouth. Bleeding, diseased gums can easily send germs into the bloodstream and eventually the heart.
  • Skin sores, STDs, or irritable bowel syndrome
  • Catheters, especially those in place long-term
  • Tattoo or piercing needles
  • IV drug use with dirty needles

 Endocarditis can damage healthy valves, or destroy already compromised or fragile valves, causing serious complications or the need for (more) surgery. There are many ways germs can get into the endocardium, but patients with congenital heart defects, artificial heart valves, damaged ‘natural’ heart valves, or a prior history of endocarditis are most at risk. Clumps of bacteria and cells, called vegetations, can even break off the infected site and travel to other organs, causing complications like stroke, seizure, kidney damage, enlarged spleen, paralysis, abscesses (aka pus) in the major organs, and even more heart problems.  

Common symptoms of endocarditis, according to the Healthline.com website, include:

Endocarditis can progress slowly or quickly, and many of these symptoms are also signs of other conditions that can impact those over 65. Seniors with – and without! – heart issues and caregivers should be alert to the symptoms of endocarditis, because early detection, prevention and intervention are always the best alternative to surgery.