CVD II - IE Flashcards
what is infective endocarditis
infection of inner layer of heart - usually affects cardiac valves
IE was almost always fatal until development of:
penicillin
what is the etiology and pathophysiology of IE
- precipitated by an infectious agent
- turbulent cardiac blood flow and damaged endothelium or heart valves permit congregation of and infection by the microbes
- morbidity accrue from thrombus formation and emboli, valvular dysfunction
prophylactic antibiotics are recommended for people in ____ cateogry
high risk
describe low risk for IE
- innocent heart murmurs
- mitral valve prolapse without regurgitation
- CAD
- people with pacemakers/defribrillators
describe moderate risk for IE
- valve repair without prosthetic material
- hypertrophic cardiomyopathy
- mitral valve prolapse with regurgitation
- acquired valvular dysfunction
describe high risk for IE
- mechanical prosthetic heart valve
- natural prosthetic heart valve
- prior IE
- valve repair with prosthetic material
- most congenital heart diseases
what conditions require AB prophylaxis
- prosthetic cardiac valve or material
- previous relapse or recurrent IE
- unrepaired cyanotic congenital heart defect or repaired heart defect
- cardiac transplant with valve regurgitation due to a structurally abnormal valve
what conditions do not require AB prophylaxis
- heart murmur
- mitral valve prolapse
- mitral valve prolapse with regurgitation
- rheumatic fever
- stent or cabg
- anesthetic injection
- radiographic imaging
- placement of RPD, removable ortho, ortho brackets
- adjustment of ortho appliances
- exfoliation of primary dentition
- bleeding for lip or oral mucosa trauma
- simple impression- alginate
- optical scans
when would a heart murmur need AB prophylaxis
if it is due to a specific cardiac condition
are prophylactic AB recommended prior to dental procedures for prosthetic joint implant patients
no
AB prophylaxis regiments for dental procedures recommended only at risk patients who have procedures that:
- manipulate the gingival tissue
- manipulate the periapex of teeth
- perforate the oral mucosa
what is OBS
if the dosage of antibiotic is inadvertently not administered before the procedure the dosage may be administered up to 2 hours after the procedure
is clindamycin recommended for AB prophylaxis and why
no due to gastric SE
what is the oral med for AB prophylaxis
amoxicillin 2g in adults 50mg/kg in children
if a patient is taking a beta-lactam (penicillin, amoxicillin) for an active, existing infection:
resistance strains have likely been selected
if urgent/emergency tx is necessary in patients already taking ABs prescribe:
azithromycin or clarithromycin
if dental treatment is elective in patients already taking ABs:
wait 10 days after completion of the antibiotic for their active infection, then prescribe amoxicillin
what is the script for amoxicillin one appointment dose prophylaxis
500mg
- dispense 4 tabs
- take 4 tabs PO one hour prior to dental appointment
what are the procedures likely to induce bleeding and bacteremia and do they require AB prophylaxis
- manipulate the gingival tissue
- manipulate the periapex of teeth
- perforate the oral mucosa
- yes
why are the procedures that do not require AB prophylaxis not require them
- they are unlikely to:
- manipulate the gingival tissue
- manipulate the periapex of the tooth
- perforate the oral mucsoa
what are predictors of IE chances
size of bacteremia or bacteria number
is IE always caused by bacterial infection
no
what are likely the cause of most cases of IE
daily exposure to bacteremias during everyday activities such as toothbrushing and chewing
