Infective Endocarditis Flashcards
What is infective endocarditis
Infection or inflammation of the endocardium
What is the endocardium
Inside surface of the heart and heart valves
What is the outcome of infective endocarditis
Leads to significant damage to the valves, requiring them to be replaced
What causes infective endocarditis
Microbial colonisation of thrombi on the endocardial surface abnormalities or thrombi on the valve leaflets
What are the organisms implicated in infective endocarditis
Mainly oral streptococci
Can be gut strep and staphylococci from the skin
What causes infective endocarditis
Bacteria entering usually the mouth, passing into circulation and then settling onto previously damaged areas of heart tissue
These bacteria will cause colonisation within a thrombus and multiply to cause damage and also spread of the infection
This leads to vegetation’s forming
What is a vegetation
A mass of platelets, fibrin, microcolonies of microorganisms, and scant inflammatory cells
Summarise the changes seen in infective endocarditis
Surface abnormalities cause haemodynamic changes which causes turbulent blood flow in that area leading to platelets and fibrin being deposited on the abnormalities
These thrombi form vegetations on the surface of the valves into which bacteria can spread from the circulation leading to enlargement of the vegetation
The enlargement of the vegetations then cause more surface abnormalities
Which group of patients are at the highest risk of infective endocarditis
Older age group
What is the most common disease to have at the time of diagnosis of infective endocarditis
No previously known cardiac problem
What are common diseases to have when being diagnosed with infective endocarditis
Prosthetic valve
Intracardiac device
What are the symptoms of infective endocarditis
Chronic fever
Small haemorrhages beneath the surface of the nails
Changes on the skin
Changing heart murmur
How can a diagnosis of infective endocarditis be reached
By taking blood cultures over several days and seeing if bacteria are present in the bloodstream coming form the infection
What damage can infective endocarditis cause to valves
Valve dysfunction
Urgent valve replacement needed
How is infective endocarditis treated
Prolonged antibiotic treatment
4+ weeks of bacteriocidal treatment
Combination of drugs given venously to ensure it gets to the tissues
Which cardiac patients are not a risk of infective endocarditis
Coronary Artery Bypass Grafting Angioplasty and Stent Hypokinetic cardiac muscle following an MI Implanted pacemaker Implanted defibrillator
What type of dental procedures are a risk for infective endocarditis
Procedures involving manipulation of the dento-gingival junction and causing a bacteraemia
Give examples of procedures which are a risk of infective endocarditis
Extractions Periodontal therapy Gingival surgery Implants Restorations - only if the gingival margin is involved or a matrix is used
Which dental procedures are questionable when thinking about infective endocarditis risk
Endodontics
Impressions
Orthodontics
What can a dentist do for patients at risk of infective endocarditis
Identify them - medical history must cover the risk conditions
Prevent oral disease and keep excellent oral hygiene
What is antibiotic prophylaxis
When antibiotics are given as a precaution to prevent rather than to treat
How should the decision on using antibiotic prophylaxis be made
Made by the patient and their physician
Communicated to the dentist in writing
When should antibiotic prophylaxis be used
Only for procedures likely to produce a significant bacteraemia through manipulation of the dental-gingival junction
