Bacteria entering the bloodstream — from the mouth, the skin, the gut, an injection or an intravenous line — can attach to a heart valve, particularly one already damaged or replaced. There they multiply within a mass of platelets and fibrin called a vegetation, protected from the immune system and partly from antibiotics.
The vegetation destroys the valve, causing it to leak, and fragments can break off and travel — to the brain causing stroke, to the kidneys, spleen, limbs or, from right-sided valves, to the lungs. Around the valve, infection can burrow into the surrounding tissue and form an abscess.
The classical presentation is a fever lasting weeks with fatigue, weight loss and night sweats, in someone who may attribute it to a persistent flu. A new or changed murmur is the key clinical finding. Small skin and nail signs occur but are less common than textbooks suggest.
Who is at risk matters here. Rheumatic valve disease, prosthetic valves, congenital heart defects, previous endocarditis and intravenous drug use all raise the risk considerably — and the first three are precisely the populations we serve. Dental infection is a frequent source, which is why dental health is not a peripheral matter for these patients.
