Endocarditis is inflammation of the inner lining of the heart chambers and valves, or endocardium. Endocarditis is a rare but life-threatening disease. In endocarditis, clumps of bacteria or fungi, along with blood cells, collect on the endocardium. These clumps occur more often on the heart valves than on the heart chambers. Pieces of these clumps can break off and travel to different parts of the body, blocking blood flow or spreading infection.
Myocarditis is an uncommon disease marked by inflammation of the heart muscle, called the myocardium, and other changes to the heart muscle cells that may be acute or chronic. Myocarditis can affect small or large sections of the heart muscle, making it harder for the heart to pump blood, which in turn can lead to heart failure.
Pericarditis is a condition in which the pericardium—the sac surrounding the heart—gets inflamed. This sac is made of two thin layers of tissue with a small amount of fluid in between. The fluid keeps the layers from rubbing against each other and causing friction. The pericardium holds the heart in its position in the chest and protects it from infection.
Depending on how long you have had it, your doctor may categorize pericarditis as acute, subacute, chronic, or recurrent, the latter meaning it is a repeat event.
Heart inflammation can be caused by infections, particularly from viruses or bacteria; medicines; or damage to the heart’s tissue or muscle from autoimmune diseases, medicines, environmental factors, or other triggers. The causes of heart inflammation may vary depending on the part of the heart that is affected—the endocardium, the myocardium, or the pericardium.
Viral, bacterial, and fungal infections can cause heart inflammation.
How do viruses cause myocarditis?
Viruses may infect the cells of the heart tissue. Once the virus is in the cell, the virus multiplies and activates the body’s immune system, leading to damage in the heart tissue. This initial phase of infection can last weeks to months.
If the viral infection lasts for a long time, it can damage the structure and function of the heart muscle and may lead to dilated cardiomyopathy.
Autoimmune diseases such as rheumatoid arthritis and lupus erythematosus may cause pericarditis or myocarditis. They can also damage the heart valves, which can lead to endocarditis.
Medicines can cause side effects that may lead to myocarditis, pericarditis, or both. These medicines include:
Environmental factors that may cause myocarditis include:
You may have an increased risk for heart inflammation such as endocarditis, myocarditis, and pericarditis because of your age, sex, genetics, environment, lifestyle, or medical conditions and procedures.
Different age groups are at risk for different types of heart inflammation:
Heart inflammation from endocarditis, myocarditis, and pericarditis is more common in men than in women, except when caused by autoimmune diseases, such as lupus and rheumatoid arthritis, which are more common in women.
Endocarditis and pericarditis occur twice as often in men as in women.
Genetics play a role in the risk of developing all three types of heart inflammation. Your genes may be partly responsible for how your body responds to infection and inflammation and whether you develop myocarditis or pericarditis.
People who have structural or congenital heart defects, such as problems with the heart valves, may be at higher risk for infection that can cause endocarditis.
Certain inherited conditions can affect your risk for heart inflammation. For example, you may be at higher risk for myocarditis and pericarditis if you have familial Mediterranean fever or tumor necrosis factor receptor-associated periodic syndrome (TRAPS). These rare conditions affect how the body controls inflammation.
Chagas disease, common in Latin America, can cause acute and chronic myocarditis. It is caused by a parasite that is spread by certain types of insects. Endocarditis caused by Streptococcus bacteria is more common in less developed countries.
Certain lifestyle choices raise your risk for endocarditis or myocarditis. These include:
Some medical conditions can increase your risk of endocarditis, myocarditis, or pericarditis. These include:
Certain medical procedures can increase your risk of endocarditis, myocarditis, or pericarditis, including:
There is no routine screening for endocarditis, myocarditis, or pericarditis. Learn about strategies that may help you prevent endocarditis. If your doctor suspects endocarditis, myocarditis, or pericarditis, you may undergo tests to diagnose your condition.
Your doctor may recommend steps to prevent bacterial growth on the endocardium in people who have risk factors for endocarditis. These steps may decrease your risk of endocarditis.
Many causes of myocarditis and pericarditis are difficult or impossible to avoid or prevent. Controlling risk factors for diseases such as HIV and avoiding substances such as amphetamines and cocaine may decrease your risk for myocarditis.
The signs, symptoms, and complications of heart inflammation depend on which type of heart inflammation you have. You may also have different symptoms than other people who have the same type of heart inflammation. Heart inflammation can happen suddenly or progress slowly and may have severe symptoms or almost no symptoms. If left untreated, complications can include serious arrhythmias, blood clots, or heart failure.
If a virus causes your heart inflammation, you may have a cough, runny nose, or gastrointestinal symptoms a few weeks before symptoms of your heart inflammation. The signs and symptoms of heart inflammation are different depending on the type of heart inflammation you have.
Complications of heart inflammation vary depending on the type of heart inflammation. Some complications can be life-threatening.
Your doctor will diagnose heart inflammation such as endocarditis, pericarditis, or myocarditis based on your medical history, a physical exam, and diagnostic tests and imaging studies. The cause of the inflammation may remain unknown, which is often the case with pericarditis.
Because the signs and symptoms of heart inflammation vary among the three types and from one person to the next, it is sometimes difficult to diagnose endocarditis, pericarditis, or myocarditis. To help, your doctor may ask questions such as these:
During the physical exam, your doctor may take these steps:
Your doctor may recommend other tests and procedures to diagnose the different types of heart inflammation, including:
Blood tests may help your doctor find the cause of your heart inflammation and may include:
Your doctor may order additional tests to find out whether another condition may be causing your symptoms.
If you are diagnosed with heart inflammation such as endocarditis, myocarditis, or pericarditis, your doctor may recommend medicine or surgery to treat your condition. Mild cases of myocarditis and pericarditis may go away without treatment.
Your doctor may prescribe one or more medicines to treat heart inflammation, depending on the type and cause of heart inflammation.
Your doctor may consider procedures and surgeries to treat your heart inflammation, including:
Your doctor may recommend lifestyle changes depending on the cause of your heart inflammation. These recommendations may include:
Follow up with your doctors as instructed. Your exact follow-up will depend on the cause and severity of your disease. Ongoing medical care may include:
Return to Treatment to review possible treatments for endocarditis, myocarditis, and pericarditis.
Your doctor may recommend the following to monitor your condition and the effectiveness of the treatments:
Make sure you are familiar with the signs and symptoms of your condition, such as chest pain, cough, fever, and shortness of breath. Call your doctor with any new symptoms.
Repeat events of heart inflammation can happen. People with endocarditis have a lifelong risk. Repeat events of pericarditis are common in the first 18 months after treatment. People with myocarditis are at risk for a repeat event for years after the first occurrence.
To prevent complications, it is important to take these steps:
Serious complications can include repeat events and new or worsening heart failure. Tell your doctor if you experience fever or chills, or symptoms of heart failure, such as shortness of breath, fatigue, or swelling in your legs.
Review the symptoms and complications of the different types of heart inflammation from endocarditis, myocarditis, and pericarditis.
Depending on the cause and amount of heart inflammation, you may need treatments to manage complications.
In support of our mission, we are committed to advancing research on endocarditis, myocarditis, and pericarditis in part through the following ways. Research on this topic is part of the NHLBI’s broader commitment to advancing heart and vascular disease scientific discovery.
Learn about exciting research areas the NHLBI is exploring in endocarditis and myocarditis.
We lead or sponsor many studies aimed at preventing, diagnosing, and treating heart, lung, blood, and sleep disorders.