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What is "Endocarditis"?

Endocarditis is an infection of the heart valves and parts of the inside lining of the heart muscle (known as the "endocardium"). This is an uncommon, but not rare, infection. It is often very serious. The infection may begin at the time of a dental or medical procedure in someone who has a predisposing abnormality of their heart. It may also occur in someone who has had no previous problem with their heart, and who has not had any other procedure which is associated with a risk of endocarditis.
Bacteria often find their way into our blood in the midst of our normal day. Activities such as chewing or having a bowel movement typically push some bacteria into the bloodstream. The body has set up elaborate and effective ways of dealing with these events the most important of which is a smooth and continuous surface throughout the heart and blood vessels. Bacteria simply have no place to attach, and if they do, the body can kill the bacteria promptly.

If a large number of bacteria enters the bloodstream and a condition exists, such as some types of valve deformities, the bacteria can gain a foothold on an area where the lining is not perfect. Once the bacteria have "set up shop", they have access to a wonderful source of nutrition -- the patient's bloodstream which contains all of the materials they could want.

The bacteria can form "vegetations" on the valve they infect. These vegetations are often only lightly adherant to the valve, and may break off into the blood stream. These can act like clots, blocking off flow in the arteries where they travel. Furthermore, they can spread the infection to multiple places in the body.
A person with this type of infection may initially have only vague and mild symptoms which are ignored by the patient or misdiagnosed by the healthcare practitioner. On the other hand, if the infecting bacteria is a very aggressive type, the patient may be severely ill from the onset.

This condition requires long-term antibiotics (often four-to-six weeks, or more) and may require valve replacement. Also, see the next section on prevention.

Do I need to take antibiotics prior to dental work and other procedures?

Antibiotics are often prescribed prior to some dental and medical procedures for people with certain conditions. People who require this have a heart or other condition that makes it easier for an infection to occur. They are given the antibiotics prior to procedures that are associated with bacteria being released into the bloodstream.
Not all people, even those with heart conditions, need to take antibiotics. Furthermore, even if antibiotics are used, they are not used for simply any procedure. An outline of some of the factors involved is listed below.

Cardiac conditions associated with risk for Endocarditis

This is best conceived of as a spectrum of risk.

Highest risk

     Artificial heart valves
     Prior episodes of endocarditis
     Some complex congenital heart defects and repairs

Moderate risk
     Some less complex congenital defects
          Patent ductus arteriosus, Ventricular septal defect, "Primum" atrial septal defect,
                 coarctation of the aorta, bicuspid aortic valve
     Hypertrophic cardiomyopathy
     Some cases of rheumatic or other types of valvular heart disease
     Mitral valve prolapse with mitral regurgitation

Low risk (equal to people without underlying cardiac defects)
     "Secundum" atrial septal defects
            Atrial or ventricular septal defect, or patent ductus arteriosus surgically closed greater than 6 months
     "Innocent" heart murmurs
     Prior bypass surgery
     Mitral valve prolapse without regurgitation
            Persons with pacemakers or implantable defibrillators
     History of rheumatic fever without residual problems

For which procedures should antibiotics be taken?

The list is long, and more importantly, very specific. For this latter reason, I am not including it here. You may access the entire and current recommendations on the American Heart Association site. http://www.amhrt.org/.
A good rule of thumb is to remind anyone who is to do a procedure to you that you have a condition that requires antibiotic prophylaxis in some cases, and ask them specifically about the one they are about to do to you.

©COPY;1997 HeartPoint   Updated May 1998

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