valvular heart disease, congenital heart disease and infective endocarditis Flashcards
what side of the heart does valvular heart disease affect the most?
LHS
what valves are affected? and where are they situated?
aortic valve- between LV and aorta
mitral valve- between LV and LA
what causes valvular heart disease?
-age
-congenital
-IE- bacteria on heart valves
-Rheumatic fever- complication of streptococcal infection
what are the two pathologies of valvular heart disease?
1- regurgitation
2-stenosis
what happens during regurgitation?
- heart valves lose structural integrity and become floppy/leaky
-blood regurgitates back to heart chamber and blood therefore flows the wrong way
-leads to heart failure
what happens during stenosis?
-valves narrow and reduce blood flow
-inadequate outflow of blood
-leads to heart failure
how do you treat valvular heart disease?
-medication to treat heart failure
-surgery
what are the 3 ways to replace valves?
-biological replacement e.g porcine
-mechanical replacement- metal valves
-transcatheter aortic valve implantation (TAVI)- biological
what is needed post surgery for biological valve replacements?
short term anticoagulant e.g warfarin
what is needed post surgery for mechanical valve replacements?
life-long anticoagulants e.g warfarin
what is needed post surgery for a TAVI valve replacement?
biological but does not require anticoagulants
- WILL require life long antiplatelet therapy
what are the dental aspects of valvular heart disease and valve replacements?
anticoagulants- check INR- warfarin ranges from 2.5-3
if over 4- postpone treatment
patients will be at an increased risk of infective endocarditis= more prone to bacteria on valves- either through invasive procedures (even toothbrushing) or occur spontaneously (gingivitis or caries)
therefore- its important to maintain good OH and treat perio and caries to reduce risk.
what congenital heart disease does not increase the risk of infective endocarditis?
atrial septal defect- pressure of blood in left atrium higher than right atrium.
what may patients with congenital heart disease not be able to do in a dental surgery?
lie flat- as they will become breathless
what does infective endocarditis cause?
bacterial vegetation on diseased, prosthetic or normal heart valves
what are the clinical features of infective endocarditis ?
-prolonged febrile illness (i.e prolonged fever)
-valve degeneration/failure
-embolic disease (vegetation travels through circulation to another part of body e.g brain/skin)
-kidney failure
how would you diagnose infective endocarditis?
-blood culture- to determine antimicrobial therapy
-echocardiogram - may see vegetation
what is the treatment for infective endocarditis?
-surgery/replacement
-prolonged course of IV antibiotics (4+ weeks)
what is the dose for adult patients with no penicillin allergy?
amoxycillin- 3g 60 mins before
what is the dose for child patients with no penicillin allergy?
amoxycillin- 50mg/kg max 600mg
what is the dose for adult patients with a penicillin allergy?
clindamycin- 600mg
what is the dose for child patients with a penicillin allergy?
clindamycin- 20mg/kg max 600mg
list those at risk of infective endocarditis?
-those with acquired valvular heart disease with regurgitation or stenosis
-those with prosthetic valve replacements
-those who have had pervious IE
-those with congenital heart disease (except atrial septum defect)
-hypertrophic cardiomyopathy (genetic condition)
what patients should be under consideration for antibiotic prophylaxis?
-those with prosthetic heart valve replacements
-those with previous IE
-those with congenital heart disease (except atrial septum defect)
what should you explain to patients about antibiotic prophylaxis?
-risks/benefits of ab prophylaxis
-why it is not routinely used- evidence/resistance
-symptoms of IE
-the importance of good OH
who should you contact before treatment of high risk infective endocarditis patient?
their cardiologist
what resources should you utilise to assist your decision making when treating patients at risk of infective endocarditis?
NICE and SDCEP
