Medical Specialty >> Cardiology

Doctors Lounge - Cardiology Answers

Back to Cardiology Answers List

If you think you may have a medical emergency, call your doctor or 911 immediately. Doctors Lounge ( does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Site. 

DISCLAIMER: The information provided on is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician. Please read our 'Terms and Conditions of Use' carefully before using this site.

Date of last update: 10/20/2017.

Forum Name: Valvular Heart Diseases

Question: Endocarditis Fear!

 emmylala2003 - Tue Jan 11, 2005 12:36 pm


Well, I had my colonoscopy done on Friday and all went well. My doctor adopted the better safe than sorry approach and gave me antibiotics before the procedure anyway. Only she didn't administer them 30 minutes before had, as is the norm, but just before the procedure using an IV. I was told I had hemmorhoids and nothing more. However, now I'm feeling a little fearful of endoacrditis because I've been feeling tired and cold these last couple of days, also I've noticed a red bloch on the palm of my hand a few days ago (Janeway lesion???) although I confess this may have been there even before the procedure, I'm so nervous, I can't really remember. How long does it take for endocarditis to manifest symptoms? and what are the tell tale signs, one is infected? I'm not sure if I'm just being paranoid or what. Before I knew I had MVP w/ moderate reg. I'd gone to the dentist and even had my wisdom tooth pulled without a problem. Also, I'm confused about how one could contract endocarditis from a colonoscopy? If the reason is that polpys can be removed during the procedure and provide an enterance for bacteria, can't the same be said for people like me who have hemmorhoids?

Please help me put this into perspective.
 Dr. Yasser Mokhtar - Tue Jan 11, 2005 3:48 pm

User avatar Dear Emmylala2003,

Thank you very much for the update.

First of all, colonoscopy with or without a biopsy or a polyp removal is not of the procedures that produce high degree bacteremia incriminated in the etiology of infective endocrditis such as dental extraction for example. That is why it is not recommended that patients at risk for endocarditis receive antibiotics routinely before this procedure.

i don't think that there is a problem if you had the antibiotic just before the procedure as opposed to 30 minutes before the procedure.

i don't think that there is any relation between hemorrhoids and endocarditis unless hemorrhoids get infected and the infection spreads into the blood stream.

There is an incubation of less than 2 weeks in most of the cases between the procedure that caused bactermia and the begining of endocarditis.

Symptoms of endocarditis include fever, chills, loss of appetite, malaise, fatigue, weight loss and night sweats but all of these symptoms are non-specific.

Signs include skin manifestations (such as the Janeway nodules that you referred to which are thought to be due to embolization to the skin), embolic manifestations to major organs such as the brain, enlarged spleen and development of kidney failure. Heart signs include the development of a new murmur or the change in the characterisitics of an old murmur is a very strong indication of endocarditis but don't occur that frequently.

If you are worried, please, start charting your temperature and if at any time you start to develop a fever, call your doctor immediately. If you want to call your doctor now to make him/her aware of what you are thinking, go ahead and do it.

Thank you very much for using our website and i hope that this information helped.

Yasser Mokhtar, M.D.
 emmylala2003 - Tue Jan 11, 2005 4:28 pm

Thank you for your response. I guess what I was looking for, more than anything, was the likelihood that this procedure could cause endocarditis and if so, would it manifest itself 2 or 3 days after the procedure. Based on the information you've given me, and the information I have provided you with, it seems that the liklihood of infection from the colonoscopy is very small and that it might be too soon to be exhibiting symptoms, given the fact that the procedure was done only 3 days prior to the start of these symptoms I've described. Would that be a fair assumption? Also, would it be reasonable to suggest that I wait and seem what happens, and should I develop any further symptoms like fever, weight loss etc... make arrangements to see my doctor?

Lastly, how is endocarditis diagnosed? Blood test? Culture? TTE?
 Dr. Yasser Mokhtar - Tue Jan 11, 2005 6:17 pm

User avatar Dear Emmylala2003,

Thank you very much for the update.

i think the likelihood of these symptoms being endocarditis are very small. First, because colonoscopy usually is not associated with bacteremia. Second, because even though it was not recommended to receive antibiotics for colonoscopy, you were treated as if this was a high risk procedure and you received antibiotics. Third, the symptoms that you are experiencing now are non-specific and are not suggestive of endocarditis.

Diagnosis of endocarditis depends on proving that the endocardium is infected during a clinical context that is supicious of endocarditis. In addition to the clinical context (example patient who had a tooth extraction and has a diseased valve or an artificial valve and starts to have fever), symptoms and signs and then blood tests such as postive blood cultures (even though in some cases of endocarditis blood cultures are negative) are very helpful. To confirm the diagnosis a transthoracic echocardiogram is done, if it is positive well and good, if negative and there is strong suspicion for endocarditis, a transesophageal echocardiography is done. If the suspicion for endocarditis is low, another diagnosis is to be considered.

If you want to talk to your doctor now about your thoughts, go ahead and talk to him/her and you don't have to go in to be seen now. If you don't want to talk to your doctor, watch your temperature and if you develop fever, call your doctor immediately.

Thank you very much for using our website and i hope that this information helped.

Yasser Mokhtar, M.D.

| Check a doctor's response to similar questions

Are you a Doctor, Pharmacist, PA or a Nurse?

Join the Doctors Lounge online medical community

  • Editorial activities: Publish, peer review, edit online articles.

  • Ask a Doctor Teams: Respond to patient questions and discuss challenging presentations with other members.

Doctors Lounge Membership Application

Tools & Services: Follow DoctorsLounge on Twitter Follow us on Twitter | RSS News | Newsletter | Contact us