Infective Endocarditis Flashcards
What is infective endocarditis (IE)?
An infection of the endocardium, often affecting heart valves, usually caused by bacteria, sometimes fungi.
How common is infective endocarditis?
It is relatively rare, with 3–10 cases per 100,000 people annually.
What are two common organisms that cause IE?
Staphylococcus aureus (skin) and Streptococcus viridans (oral cavity).
Why are heart valves vulnerable to infection?
They are poorly vascularised, limiting immune access.
What is the pathogenesis of infective endocarditis?
Bacteria enter the bloodstream, attach to damaged endocardium or prosthetics, and form vegetations.
What are vegetations in IE composed of?
Platelets, fibrin, microorganisms, and inflammatory cells.
List 6 risk factors for infective endocarditis.
Prosthetic valves, congenital defects, prior IE, IV drug use, implanted devices, immunosuppression.
Can IE occur without identifiable risk factors?
Yes, up to 50% of cases occur without known risk factors.
Why is IE historically relevant to dentistry?
Because oral bacteria like S. viridans can cause IE, especially after dental procedures.
Which common dental activities can cause bacteraemia?
Tooth brushing, chewing, periodontal therapy, extractions, scaling/root planing.
List 6 clinical signs/symptoms of IE.
Fever, fatigue, night sweats, splinter haemorrhages, weight loss, heart murmur.
What symptoms should raise suspicion of IE?
Persistent fever, night sweats, fatigue, history of heart problems.
How is infective endocarditis treated?
Hospital admission, IV antibiotics, and possible surgical removal of infected tissue.
Why is early treatment important for at-risk patients?
To prevent progression from local infection to infective endocarditis.
What was the traditional antibiotic prophylaxis for dental procedures?
3g Amoxicillin or 600mg Clindamycin orally 1 hour before the procedure.
What is NICE’s current stance on routine prophylaxis for IE?
Not recommended for dental or non-dental procedures.
Why did NICE discontinue routine prophylaxis?
Due to lack of strong evidence, risk of resistance, and side effects of antibiotics.
What should dentists discuss with high-risk patients?
Risks/benefits of antibiotics, importance of oral health, signs of IE, risks of invasive procedures.
Should chlorhexidine be used to prevent IE before dental procedures?
No, NICE does not recommend it for IE prophylaxis.
When should a dentist consult a cardiologist?
If uncertain about prophylaxis or when managing a complex cardiac history.
What are a dentist’s responsibilities regarding IE?
Identify risk, promote hygiene, manage infections, educate patients, avoid unnecessary antibiotics, document informed consent, refer when needed.
