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Endocarditis

Also listed as: Heart infection - endocarditis

• Signs and Symptoms
• What Causes It?
• What to Expect at Your Provider's Office
• Treatment Options
• Following Up
• Supporting Research

Endocarditis is an inflammation of the endocardium, the membrane that covers connective tissue in heart valves and lines heart chambers. Most cases are caused by a bacterial infection. Endocarditis is a serious ailment that can lead to severe medical complications, and can even be fatal if not treated.

Signs and Symptoms

The most common symptom of endocarditis is fever. The fever may be high or low, and it may seem to come and go. Other common symptoms include the following:

• Chills
• Muscle weakness
• Fatigue
• Muscle, joint, back pain
• Night sweats
• Shortness of breath
• Cough
• Unnatural pallor
• Weight loss
• Heart murmur
• Painful spleen or abdomen
• Bloody urine
• Stiff neck
• Seizures
• Heart attack
• Cold, painful hands and feet
• Painful tips of fingers or toes

What Causes It?

Most causes of endocarditis are related to a bacterial infection. Usually your body fights off an infection, even if bacteria reach your heart. But when heart valves or tissue are damaged, they provide a good place for bacteria to lodge and multiply. Your risk of endocarditis increases if you have heart disease or mechanical heart valves. Procedures that increase your risk of endocarditis include dental procedures that irritate the gums, tonsillectomy, adenoidectomy, intestinal and respiratory surgery, gallbladder surgery, cystoscopy, bronchoscopy, and vaginal delivery with an infection present.

What to Expect at Your Provider's Office

Your health care provider will listen to your heart and lungs, take your pulse, and check your eyes and skin. They likely will order several tests, which could include blood tests, urine analysis, an echocardiogram, a computed tomography (CT) scan, and a cinefluoroscopy (a motion-picture type heart scan). Usually, your provider will admit you to the hospital, possibly in intensive care, until your symptoms are under control.

Treatment Options

Endocarditis is treated with high doses of antibiotics, almost always intravenously. Sometimes, surgery is also required.

Drug Therapies

Endocarditis is usually treated with a combination of two or even three antibiotics, such as penicillin, gentamicin, vancomycin, cefazolin, ceftriaxone, nafcillin, oxacillin, rifampin, and ampicillin. Treatment is determined by what type of bacteria is infecting your heart and generally takes 2 - 6 weeks.

Complementary and Alternative Therapies

Endocarditis has serious ramifications and requires aggressive medical treatment. Alternative therapies may be used concurrently to help reduce severity, duration, and progression of disease, but endocarditis should never be treated with alternative therapies alone. Make sure all of your health care providers are informed of alternative medicine therapies or supplements you are using.

Nutrition

• To support immune function, include vitamins C (1,000 mg up to three times per day; lower dose if diarrhea develops), E (400 - 800 IU per day), A (10,000 IU per day) or beta-carotene (100,000 IU per day), plus selenium (200 mcg per day), and zinc (30 mg per day).
• Coenzyme Q10 (100 mg twice a day) protects the heart.
• Magnesium (200 - 500 mg two to three times per day) for normal cardiac function. Do not take if you have kidney damage.
• Bromelain (250 - 500 mg three times per day between meals) helps fight inflammation and may increase the effectiveness of antibiotic therapy.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

Take these herbs only under your doctor's supervision. For support of your heart:

• Hawthorn ( Crataegus monogyna), 240 - 600 mg per day
• Motherwort (Leonurus cardiaca), 2 g or 1 cup tea two or three times per day. To make tea, steep 2 g in one cup boiling water. Strain and cool
• Linden ( Tilia cordata) , 1 - 2 cups tea per day. To make tea, steep 2 g in one cup boiling water. Strain and cool.
• Asian ginseng ( Panax ginseng) , 200 - 600 mg per day
• Garlic ( Allium sativum) , 600 - 900 mg per day

For immune system support:

• Coneflower ( Echinacea spp .), 500 - 1,000 mg three times per day
• Goldenseal ( Hydrastis canadensis), 500 -1,000 mg three times per day; often used with coneflower
• Wild indigo ( Baptisia tinctoria ), 1 cup of tea three times per day. To make tea, steep 500 - 1,000 mg dried root in one cup boiling water; strain and cool.
• Andrographis ( Andrographis paniculata) , 400 mg three times per day

Homeopathy

Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies as a supplemental treatment for the symptoms of endocarditis as long as the underlying infection has been appropriately treated. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

• Aconite if you fear death, have rapid heartbeat (tachycardia) with full, hard bounding pulse of sudden onset
• Cactus grandiflorus for endocarditis with mitral insufficiency. You may have a feeble, irregular pulse and feel a chest constriction
• Digitalis if you have an irregular pulse with a sensation as if your heart would stop if you moved
• Spongia if you have a sensation of the heart swelling

Acupuncture

Acupuncture may help improve immunity and strengthen cardiac function.

Following Up

In addition to monitoring your condition while you are in the hospital, your health care provider will order follow-up procedures, such as blood tests, to determine how well the prescribed treatment is working.

Supporting Research

Barker LR, Burton JR, Zieve PD, eds. Principles of Ambulatory Medicine. 4th ed. Baltimore, Md: Williams & Wilkins; 1995:379-381.

Bartram T. Encyclopedia of Herbal Medicine. Dorset, England: Grace Publishers; 1995:99,167-168,220.

Castro, M. The Complete Homeopathy Handbook . New York: St. Martin's Press; 1990.

Coon JT, Ernst E. Andrographis paniculata in the treatment of upper respiratory tract infections: a systematic review of safety and efficacy. Planta Med . 2004;70:293-8.

Endocarditis: a rare but serious disease. Drug Ther Perspect. 1998;12(4):6-9.

Gruenwald J, Brendler T, Jaenicke C, et al., eds. PDR for Herbal Medicines. Montvale, NJ: Medical Economics Co; 1998:772-773, 1130-1131.

Ivanovska N, Philipov S. Study on the anti-inflammatory action of Berberis vulgaris root extract, alkaloid fractions and pure alkaloids. Int J Immunopharmac. 1996;18(10):553-561.

Liu CX, Xiao PG, Liu GS. Studies on plant resources, pharmacology and clinical treatment with berbamine. Phytotherapy Research. 1991;5:228-230.

Murray MT. Encyclopedia of Nutritional Supplements. Rocklin, Calif: Prima Publishing; 1996:401,404, 463-464.

Snow JM. Hydrastis canadensis L. (Ranunculaceae). Protocol J Botan Med. 1997;2:25-28.

Stein JK, ed. Internal Medicine. 4th ed. St. Louis, Mo: Mosby-Year Book; 1994:189-201.

Stoller JK, Ahmad M, Longworth DL, eds. The Cleveland Clinic Intensive Review of Internal Medicine. Baltimore, Md: Williams & Wilkins; 1998:137-141, 299.

Walker LP, Brown EH. The Alternative Pharmacy. Paramus, NJ: Prentice Hall Press; 1998:239-240.

Werback MR. Nutritional Influences on Illness. New Canaan, Conn: Keats Publishing, Inc; 1987:252-262.

Zapfe jun G. Clinical efficacy of crataegus extract WS 1442 in congestive heart failure NYHA class II. Phytomedicine . 2001;8:262-6.

• Review Date: 9/1/2006
• Reviewed By: Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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