Complications in other parts of the body

Small bits may break off from the vegetations on the infected heart valves. These get carried in the bloodstream, and lodge in other parts of the body. This can cause various symptoms. For example:

• Small spots may appear under the fingernails, in the eyes, or other parts of the body.
• Infections may develop in other parts of the body.
• The spleen may enlarge as it is the main organ that fights off blood infections.
• If a larger chunk of vegetation breaks off then it can block the blood flow in a main artery. For example, if it gets stuck in an artery in the brain it can cause a stroke or sudden loss of vision in one eye.

How does infective endocarditis occur and progress?

Most cases are caused by infection with bacteria. A small number of cases are caused by infection with fungi.

To develop this infection you need to have some bacteria or fungi in the bloodstream. The blood usually does not contain any bacteria or fungi. However, some may get into the blood if you have an infection or wound in another part of the body.

People who inject street drugs may also inject bacteria or fungi into their bloodstream if they use dirty or contaminated needles.

Most bacteria that get into the bloodstream are killed by the immune system. However, sometimes some bacteria survive and settle on a heart valve (particularly if the valve is already damaged in some way), or on another section of the endocardium. Once a small focus of infection develops in the endocardium it is difficult for the immune system to clear it.

In time, small clumps of material called vegetations may develop on infected valves. The vegetations contain bacteria or fungi, small blood clots, and other 'debris' from the infection. The vegetations may prevent affected valves from opening and closing properly. The infection can also damage affected valves, and may spread to other areas of the endocardium or heart tissue. Fragments of the vegetations may also break off and travel in the bloodstream to other parts of the body.

Slowly developing infection

In many cases the infection develops quite slowly. This is sometimes called 'sub-acute bacterial endocarditis' or 'SBE'. Symptoms can develop gradually, over weeks or months, and can be vague at first. You tend to feel generally unwell and may have general aches and pains, tiredness, and be off your food. A fever (a high temperature) develops at some stage in most cases. As these first symptoms can be caused by a lot of other conditions, the cause of the symptoms may not be diagnosed for some time.

Heart murmurs tend to develop. These are sounds that can be heard by a doctor listening to your heart with a stethoscope. Murmurs are caused by abnormal flow of blood through faulty or damaged valves. If you already have a heart murmur from an existing valve problem, the murmur may change or become more intense. A new or changing murmur is often what alerts a doctor to suspect infective endocarditis.

Who gets infective endocarditis?

Endocarditis is uncommon. In the UK it occurs in about 20 in a million people each year. It can occur in anybody, but the risk of developing it is increased in people who have:

• Heart valve problems or an artificial heart valve. Heart valves that are already damaged or abnormal are more likely to become infected.
• Had surgery to a heart valve.
• Certain congenital heart defects.
• A heart condition called hypertrophic cardiomyopathy.
• Had a previous episode of infective endocarditis.
• Been injecting street drugs such as heroin with dirty or contaminated needles.
• A poor immune system. For example, people with AIDS.

Diabetes Prevention

Eat Better

A daily diet of foods that are low in fat and calories—fruits, vegetables, and whole grains—is a simple and effective way to lower your risk of developing diabetes. Learn more healthy eating tips for diabetics.

Get More Exercise

Getting 30 minutes of moderate physical activity each day—a bike ride, light swimming, or a brisk daily walk—can help reduce your risk of diabetes and benefit your overall mental and physical health. Get tips on starting and maintaining a safe exercise routine.

Lose Excess Pounds

To keep your weight in a healthy range, especially as you age, you’ll need to maintain a healthy diet and continue to exercise regularly. If you’re overweight, losing even five percent of your body weight can reduce your risk of diabetes.

Diabetes Tests

Fasting Blood Glucose (FPG) Test

This is one of the most common and preferred tests; it measures blood glucose in a person who has not eaten anything for at least eight hours. Both diabetes and prediabetes can be diagnosed this way. A blood glucose level of 126 milligrams per deciliter (mg/dL) or higher indicates diabetes.

Random (Non-fasting) Plasma Glucose Test

This measures blood glucose without fasting. This test, along with an assessment of symptoms, is used to diagnose diabetes but not prediabetes. A blood glucose level of 200 mg/dL or higher indicates diabetes.

Oral Glucose Tolerance Test (OGTT)

This blood glucose test, administered after fasting for at least eight hours, is performed two hours after drinking a glucose-containing beverage. It is also common to test blood prior to the glucose drink and then every 30 to 60 minutes afterwards for up to three hours. Both diabetes and prediabetes can be diagnosed this way, and it is routinely used to screen for gestational diabetes. A blood glucose level of 200 mg/dL or higher (two hours after drinking a beverage containing 75 grams of glucose) indicates diabetes. Because glucose levels are normally lower during pregnancy, gestational diabetes is based on slightly different numbers: 155 mg/dL two hours after drinking the glucose beverage.