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Misdiagnosis of Endocarditis: Failure to Diagnose Heart Infections

Excerpt: Infective endocarditis — an infection of the heart valves — is a life-threatening condition that is frequently misdiagnosed as a less serious illness. When the diagnosis is delayed, the result can be catastrophic.

What Is Infective Endocarditis?

Infective endocarditis (IE) is an infection of the endocardium — the inner lining of the heart, particularly the heart valves. It occurs when bacteria (or, less commonly, fungi) enter the bloodstream and attach to damaged heart valves or other areas of the endocardium.

Endocarditis is a medical emergency. Without prompt diagnosis and treatment with intravenous antibiotics — and sometimes surgery to repair or replace the damaged valve — the infection can destroy the heart valves, cause heart failure, stroke, sepsis, and death.

The mortality rate for untreated endocarditis approaches 100%. Even with treatment, mortality ranges from 15-30% depending on the organism and the patient's condition. Every day of delayed diagnosis increases the risk of permanent valve damage and death.

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Risk Factors for Endocarditis

Physicians should consider endocarditis in patients with:

• Prosthetic heart valves — The highest risk group
• Congenital heart disease
• Previous endocarditis
• Intravenous drug use (IVDU) — A major risk factor
• Poor dental hygiene — Bacteria from the mouth can enter the bloodstream
• Indwelling catheters — Central lines, hemodialysis catheters
• Recent medical procedures — Dental work, surgery, or catheterization

Signs and Symptoms of Endocarditis

Classic Presentation

• Fever — The most common symptom; may be low-grade and intermittent
• New or changed heart murmur — From valve damage
• Fatigue
• Weight loss
• Night sweats

Embolic Phenomena

Endocarditis can cause pieces of the infected vegetation to break off and travel through the bloodstream:

• Stroke — From cerebral embolism
• Splenic infarction — Left upper quadrant pain
• Renal infarction — Flank pain, hematuria
• Mesenteric ischemia — Abdominal pain
• Peripheral embolization — Cold, painful extremity

Skin Findings

• Petechiae — Small red spots on the skin or conjunctiva
• Splinter hemorrhages — Linear streaks under the fingernails
• Janeway lesions — Painless red spots on palms and soles
• Osler nodes — Painful nodules on finger and toe pads

How Endocarditis Is Misdiagnosed

1. Attribution to a "Viral Illness"

Because endocarditis presents with fever, fatigue, and body aches, it is frequently dismissed as a "viral illness" or "flu." If the physician does not listen for a heart murmur — or does not investigate a fever of unknown origin — endocarditis may go undiagnosed.

2. Failure to Obtain Blood Cultures

The standard of care for a patient with unexplained fever — especially with risk factors for endocarditis — requires blood cultures. Multiple sets of blood cultures are the primary diagnostic test for endocarditis. Failure to obtain blood cultures may be negligence.

3. Failure to Perform Echocardiography

An echocardiogram — particularly a transesophageal echocardiogram (TEE) — is the standard for diagnosing endocarditis. It can visualize the vegetations on the heart valves. Failure to order an echocardiogram when endocarditis is suspected may be negligence.

4. Failure to Recognize Embolic Complications

When a patient presents with a stroke — particularly a young patient or one with risk factors — the physician should consider endocarditis as a cause. Failure to investigate endocarditis in a young stroke patient is a common and dangerous diagnostic error.

5. Failure to Consider IV Drug Use

Patients who use intravenous drugs are at extremely high risk for endocarditis. If the physician fails to take a thorough history that reveals IV drug use — or dismisses the possibility — endocarditis may go undiagnosed.

Consequences of Delayed Diagnosis

• Valve destruction — Requiring valve replacement surgery
• Heart failure — From valve damage
• Stroke — From cerebral embolism
• Sepsis — Systemic infection
• Abscess formation — In the heart or other organs
• Death — From heart failure, sepsis, or stroke

Proving an Endocarditis Misdiagnosis Claim

Key Evidence

• Medical records — Documenting the patient's presentation, risk factors, and the physician's evaluation
• Blood culture results — Whether cultures were obtained and what they showed
• Echocardiogram reports — Whether imaging was ordered and what it showed
• Pathology reports — If surgery was performed, showing valve damage
• Expert testimony — From an infectious disease specialist and cardiologist

Expert Witnesses

Endocarditis cases require testimony from:

• An infectious disease specialist — On the standard of care for diagnosing and treating endocarditis
• A cardiologist — On cardiac evaluation and management
• A cardiothoracic surgeon — If valve surgery was needed
• A neurologist — If stroke occurred

Statute of Limitations

Under CPLR 214-a, the statute of limitations is 2.5 years from the date of the malpractice.

Frequently Asked Questions

What is infective endocarditis?

Infective endocarditis is an infection of the heart valves caused by bacteria (or fungi) entering the bloodstream and attaching to the heart. It is a medical emergency requiring prompt diagnosis and treatment.

How is endocarditis diagnosed?

Endocarditis is diagnosed through blood cultures (to identify the organism) and echocardiography (to visualize the vegetations on the valves). A transesophageal echocardiogram (TEE) is the most sensitive test.

Can endocarditis be misdiagnosed as the flu?

Yes. Because endocarditis presents with fever, fatigue, and body aches, it is frequently dismissed as a viral illness. The standard of care requires blood cultures and consideration of endocarditis in patients with unexplained fever — especially those with risk factors.

What happens if endocarditis is not treated promptly?

Without prompt treatment, endocarditis can destroy heart valves, cause heart failure, stroke, sepsis, abscess formation, and death. The mortality rate for untreated endocarditis approaches 100%.

How long do I have to file a claim?

Under CPLR 214-a, the deadline is generally 2.5 years from the date of the malpractice.

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If you or a loved one has been affected by endocarditis misdiagnosis in New York, contact MDLaw Firm at 347-524-5777 for a free consultation.

This article is for informational purposes only and does not constitute legal advice. Prior results do not guarantee a similar outcome. No attorney-client relationship is created by reading this article or contacting MDLaw Firm.