Skip to content
How It Works
Explore
Resources Ask a Question
Who It's For
Patients
Decode results, prep for appointments, weigh options.
Caregivers & advocates
Carry the research load for someone you love.
Providers & clinicians
Resources for patients in your practice.
Log In Ask a Question
PubMed This is a summary of 17 peer-reviewed journal articles Updated
Cardiology

Protecting Your Heart: Life After Endocarditis

At a Glance

After surviving infective endocarditis, you face a higher risk of the infection returning. Long-term prevention requires taking prophylactic antibiotics before invasive dental work, maintaining strict daily oral hygiene, and immediately reporting any unexplained fever to your cardiologist.

Surviving infective endocarditis (IE) is a major milestone, but the end of your hospital stay is the beginning of a new chapter in your health. Because you have had endocarditis once, your risk of having it again is significantly higher than it is for the general population [1]. Transitioning to life after the infection involves a shift from intensive treatment to a lifelong strategy of vigilance and prevention.

The Myth of “Universal” Antibiotics

For many years, the standard advice for heart patients was to take antibiotics before almost any dental or medical procedure. Today, the approach is more situational and targeted [2].

  • High-Risk Category: Because you have a history of IE, you are officially in the “high-risk” group. This means guidelines from the AHA and ESC do recommend a single dose of antibiotics before invasive dental procedures (such as extractions, root canals, or deep cleanings) [2][3].
  • Daily Hygiene is Key: Surprisingly, experts now emphasize that your daily oral hygiene—brushing and flossing twice a day—is even more important than that single antibiotic dose before the dentist [4][5]. Bacteria enter the bloodstream from your mouth every time you chew or brush; keeping your gums healthy reduces the amount of bacteria that can leak into your blood [6].

Monitoring for Recurrence

A “recurrence” happens when the infection returns. This can be a “relapse” (the same bacteria returning) or a “reinfection” (a new germ causing a new infection) [7].

  • The First Year: The risk of recurrence is highest in the first year following treatment. Your Endocarditis Team will likely schedule follow-up echocardiograms at 1, 3, 6, and 12 months to ensure your heart valves remain stable and infection-free [8][9].
  • Fever is the Flare: For the rest of your life, you must treat a fever with a “high index of suspicion.” If you have an unexplained fever, do not simply take “leftover” antibiotics, as this can mask a heart infection and delay diagnosis. Instead, contact your cardiology team immediately [10][11].

The Emotional Path to Recovery

The “invisible” part of endocarditis recovery is the psychological toll. Many survivors experience symptoms of anxiety, depression, or even PTSD following their long hospital stay and potentially life-altering surgery [12].

  • Health Anxiety: It is common to feel a surge of fear every time you feel a slight ache or a mild cold. This is a natural response to a life-threatening illness [12].
  • Shared Decision-Making: Staying active in your care and having regular check-ins with your multidisciplinary team can help reduce this anxiety by providing a clear “safety net” [8][13].

Prevention Checklist

To protect your heart moving forward, focus on these three pillars:

  1. Professional Dental Care: See your dentist at least twice a year. Ensure they know your history of endocarditis so they can provide the necessary antibiotic prophylaxis [14][15].
  2. Skin Integrity: Avoid new tattoos or piercings, as these provide a direct pathway for bacteria to enter the bloodstream. Treat any skin infections or wounds promptly [16].
  3. Vigilance: If you have any heart hardware, such as a prosthetic valve or pacemaker, you must be doubly cautious. These devices provide a permanent surface for bacteria to latch onto [7][17].

By remaining proactive, you aren’t just recovering—you are actively guarding your heart for the years to come.

Common questions in this guide

Do I need antibiotics before going to the dentist if I had endocarditis?
Yes, because you have a history of endocarditis, you are in a high-risk group. Medical guidelines recommend taking a single dose of antibiotics before invasive dental procedures, such as extractions or deep cleanings, to protect your heart.
What should I do if I get a fever after recovering from endocarditis?
An unexplained fever is a major warning sign of a potential recurrence. You should contact your cardiology team immediately rather than taking leftover antibiotics, which can mask the infection and delay a proper diagnosis.
How often do I need follow-up heart scans after endocarditis?
During your first year of recovery, your medical team will typically schedule follow-up echocardiograms at 1, 3, 6, and 12 months. These heart scans ensure your heart valves remain stable and infection-free.
Can I get a tattoo or piercing after having endocarditis?
It is recommended to avoid new tattoos or piercings after surviving endocarditis. These procedures break the skin and provide a direct pathway for bacteria to enter your bloodstream, which significantly increases your risk of reinfection.
Is it normal to feel anxious or depressed after recovering from a heart infection?
Yes, experiencing anxiety, depression, or PTSD is very common after surviving a life-threatening illness and a long hospital stay. Discussing these feelings with your doctor and seeking a therapist or support group is an important part of your recovery.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.What is my specific follow-up schedule for heart scans (echocardiograms) and blood work over the next year?
  2. 2.Since I’ve had endocarditis once, which specific dental or medical procedures now require me to take 'prophylactic' antibiotics?
  3. 3.Are there any activities, such as certain types of exercise or getting a tattoo/piercing, that I should avoid to lower my risk of recurrence?
  4. 4.Who should I call first if I develop a fever—my primary doctor or the cardiology team?
  5. 5.Can you recommend a therapist or support group familiar with the emotional toll of a major heart infection?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (17)
  1. 1

    Quantifying infective endocarditis risk in patients with predisposing cardiac conditions.

    Thornhill MH, Jones S, Prendergast B, et al.

    European heart journal 2018; (39(7)):586-595 doi:10.1093/eurheartj/ehx655.

    PMID: 29161405
  2. 2

    Antibiotic Prophylaxis and Infective Endocarditis Incidence Following Invasive Dental Procedures: A Systematic Review and Meta-Analysis.

    Sperotto F, France K, Gobbo M, et al.

    JAMA cardiology 2024; (9(7)):599-610 doi:10.1001/jamacardio.2024.0873.

    PMID: 38581643
  3. 3

    In adults, risk for infective endocarditis varied for invasive dental procedures and by antibiotic prophylaxis.

    Sacks HS

    Annals of internal medicine 2022; (175(12)):JC143 doi:10.7326/J22-0097.

    PMID: 36469928
  4. 4

    Oral hygiene and infective endocarditis: a case control study.

    Lockhart PB, Chu V, Zhao J, et al.

    Oral surgery, oral medicine, oral pathology and oral radiology 2023; (136(3)):333-342 doi:10.1016/j.oooo.2023.02.020.

    PMID: 37085335
  5. 5

    Mapping Review of the Correlations Between Periodontitis, Dental Caries, and Endocarditis.

    Dioguardi M, Guerra C, Laterza P, et al.

    Dentistry journal 2025; (13(5)) doi:10.3390/dj13050215.

    PMID: 40422635
  6. 6

    [Prevention of endocarditis in dentistry].

    Ciurus M

    Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego 2021; (49(289)):88-89.

    PMID: 33713102
  7. 7

    Long-term follow-up of patients with infective endocarditis in a tertiary referral center.

    Tahon J, Geselle PJ, Vandenberk B, et al.

    International journal of cardiology 2021; (331()):176-182 doi:10.1016/j.ijcard.2021.01.048.

    PMID: 33545260
  8. 8

    The 2023 new European guidelines on infective endocarditis: main novelties and implications for clinical practice.

    Imazio M

    Journal of cardiovascular medicine (Hagerstown, Md.) 2024; (25(10)):718-726 doi:10.2459/JCM.0000000000001651.

    PMID: 38916201
  9. 9

    Role of multimodality imaging in infective endocarditis: Contemporary diagnostic and prognostic considerations.

    Xu B, Sanaka KO, Haq IU, et al.

    Progress in cardiovascular diseases 2023; doi:10.1016/j.pcad.2023.10.007.

    PMID: 39492541
  10. 10

    Rethinking the Routine: Are Repeat Blood Cultures Necessary After Completion of Infective Endocarditis Treatment?

    Regina J, Ianculescu N, Tzimas G, et al.

    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2026; (82(3)):e471-e474 doi:10.1093/cid/ciaf617.

    PMID: 41219160
  11. 11

    Infective Endocarditis and Antimicrobial Timing: A Case for Delay?

    Stavropoulou E, Ledergerber B, Fourré N, et al.

    Open forum infectious diseases 2025; (12(10)):ofaf628 doi:10.1093/ofid/ofaf628.

    PMID: 41141452
  12. 12

    The impact of partial-oral endocarditis treatment on anxiety and depression in the POET trial.

    Bundgaard JS, Iversen K, Pries-Heje M, et al.

    Journal of psychosomatic research 2022; (154()):110718 doi:10.1016/j.jpsychores.2022.110718.

    PMID: 35078079
  13. 13

    Anesthesia Considerations in Infective Endocarditis.

    Hermanns H, Eberl S, Terwindt LE, et al.

    Anesthesiology 2022; (136(4)):633-656 doi:10.1097/ALN.0000000000004130.

    PMID: 35120196
  14. 14

    Endocarditis, invasive dental procedures, and antibiotic prophylaxis efficacy in US Medicaid patients.

    Thornhill MH, Gibson TB, Yoon F, et al.

    Oral diseases 2024; (30(3)):1591-1605 doi:10.1111/odi.14585.

    PMID: 37103475
  15. 15

    Prescription practices of antibiotic prophylaxis among patients at high risk of infective endocarditis.

    Havers-Borgersen E, Engelund AP, Butt JH, et al.

    American heart journal plus : cardiology research and practice 2023; (26()):100254 doi:10.1016/j.ahjo.2023.100254.

    PMID: 38510184
  16. 16

    Recurrent infection and embolism following tricuspid valve repair for infective endocarditis in an intravenous drug user: A clinical dilemma.

    Ahmed Y, Poon SS, Aslam U, Kumar P

    Clinical case reports 2023; (11(5)):e7177 doi:10.1002/ccr3.7177.

    PMID: 37215969
  17. 17

    The role of multimodal imaging in the diagnosis of prosthetic valve and intracardiac device endocarditis: A review.

    Daniel E, El-Nayir M, Ezeani C, et al.

    The international journal of cardiovascular imaging 2025; (41(3)):409-417 doi:10.1007/s10554-024-03277-7.

    PMID: 39585526

This information is for educational purposes and does not replace professional medical advice. Always consult your cardiology team regarding your specific follow-up care, antibiotic prophylaxis, and recovery plan.

Get notified when new evidence is published on Infective endocarditis.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.