Infective Endocarditis

Question 1

What is endocarditis?

Answer 1

Infection or inflammation of the endocardium and heart valves

Question 2

Why does infective endocarditis arise?

Answer 2

Microbial colonisation of thrombi on endocardia’s surface abnormalities or the valve leaflets

Question 3

What bacteria is commonly isolated from individuals with infective endocarditis?

Answer 3

Oral streptococci

Question 4

How can dental treatment lead to infective endocarditis?

Answer 4

Oral treatments could release bacteria into the circulation, bacteria could colonise at the heart as a consequence of bacteraemia

Question 5

What are “vegetation’s”?

Answer 5

Thickenings and areas of damage to the valves

Question 6

What occurs as a result of surface abnormalities on the heart valves?

Answer 6

Haemodynamic changes (they way blood flow)

Question 7

What haemodynamic changes occur when surface abnormalities are present on heart valves?

Answer 7

Instead of a smooth, laminar flow, the patient will have turbulent flow of blood in area of abnormalities

Question 8

what is the consequence of turbulent blood flow over valves?

Answer 8

Platelets and fibrin are deposited onto the abnormalities, forming vegetation’s on the surface of the valves into which bacteria can spread from the circulation.

Question 9

What symptoms do more than 50% of individuals with infective endocarditis experience?

Answer 9

1. Fever
2. Heart murmur
3. Embolic phenomena (e.g. splenic or renal infarction)

Question 10

What symptoms do less than 50% of individuals with infective endocarditis experience?

Answer 10

1. Skin manifestations
2. Septic complications (e.g. pneumonia, meningitis)
3. Aneurysm

Question 11

What is a fairly common skin manifestation of infective endocarditis?

Answer 11

Splinter haemorrhages

Question 12

What are splinter haemorrhages?

Answer 12

Changes in the nails where small haemorrhages can be seen

Question 13

By what means is antibiotic therapy administered for infective endocarditis?

Answer 13

Intravenously

Question 14

What cardiac patients are thought to NOT be at risk of infective endocarditis?

Answer 14

• coronary artery bypass grafting
• angioplasty and stent
• hypokinetic cardiac muscle
• implanted pacemaker
• implanted defibrillator

Question 15

Dental procedures involving manipulation of what, are at most risk of bacteraemia?

Answer 15

Those that involve manipulation of the dento-gingival junction

Question 16

What dental procedures involve manipulation of the dento-gingival junction and can cause bacteraemia?

Answer 16

• extractions
• periodontal therapy
• Gingival surgery
• implants
• some restorations

Question 17

What is the advice given by NICE guidelines 2008 on use of antibiotic prophylaxis prior to dental treatment for a patient at risk of infective endocarditis?

Answer 17

Dentists are instructed not to use antibiotic prophylaxis for patients at risk of endocarditis,
NICE states that it is ineffective

Question 18

Which guidelines on antibiotic prophylaxis for patients at risk of IE differs from NICE 2008 guidelines, stating that AP can be effective for highest risk patients?

Answer 18

European and US guidelines

Question 19

Before deciding to use antibiotic prophylaxis for treatment, who must the patient contact to justify the decision?

Answer 19

Their cardiologist or cardiac surgeon or doctor

Question 20

What is the recommended antibiotic prophylaxis regime given to patients?

Answer 20

3 grams of Amoxycillin, 1hr before treatment

Question 21

What are the pinpoint, round spots that form on skin, called, which indicate infective endocarditis?

Answer 21

Petechiae