Definitions & Terms
A microbial infection of the endothelial surface of the heart or heart valves that most often occurs in proximity to congential or acquired cardiac defects
Infective endocarditis (IE)
Demographics of pts that IE most commonly affects
Middle aged-elderly men
Most common complication of IE and leading cause of death.
Heart failure
Prophylactic antibiotic given to pts according to the AHA
2g amoxicillin 30-60min prior to procedure
A microbial infection that occurs in the endothelial lining of an artery usually adjacent to a vascular defect or prosthetic device
Infective endoarteritis
# of pts affected by IE a year in the US? Overall mortality rate?
15000 pts/yr
40% mortality rate
Classic findings in IE (3)
Fever, heart murmur, positive blood culture
If you anticipate a dental procedure to last longer than 6hr, you should
Administer an additional 2g dose
Similar and frequently indistinguishable conditions found in pts with systemic lupus erythematosus
Libman-Sacks verrucous endocarditis
3 ways IE is classified
-causative microorganism
-type of valve infected
-source of infection
Condition that tends to worsen as disease progresses
Normocytic, normochromic anemia
If antibiotic prophylaxis medication is not taken prior to procedure, alternatively you may..
Administer dosage within 2hr
This is added to penicillin to exert a synergistic killing effect on Viridans group Streptococci and S. Bovis.
Gentamicin sulfate
4 significant underlying conditions associated with IE
-Mitral valve prolapse (25-30%)
-Aortic valve disease; stenosis +/- regurgitation (30%)
-Congenital heart disease (10-20%)
-Tetralogy of Fallot (2%)
____% of cases of IE are culture negative. What is recommended in the blood culture evaluation of a pt for suspected IE?
-30%
-3 separate sets of blood cultures obtained over a 24hr period
Medication that is not recommended for pts allergic to penicillin, and why?
Cephalosporins due to cross allergenicity
Test used to confirm the presence of vegetation in pts suspected of having IE
Echocardiography, transthoracic or transesophageal
Sequence of events that result in IE from damaged endothelium.
1. Endothelium is damaged
2. Fibrin/platelets adhere to roughened endothelial surface forming small clusters
3. Bacteria is seeded into and adheres to mass.
4. Additional fibrin/platelets deposit onto surface of mass, protecting bacteria.
5. Bacteria multiply and vegetative process is established.
6. Vegetation fragments break off and embolize.
Examples of peripheral manifestations of IE due to emboli and/or immunologic responses (3-4)
-petechiae of the palpebral conjunctiva, buccal and palatal mucosa, and extremities
-Oslers nodes (small, tender, subcutaneous nodules develop in pulp of digits)
-Janeway lesions (small, erythematous or hemorrhagic macular nontender lesions on palms and soles)
-splinter hemorrhages in nail beds
-Roth spots (oval retinal hemorrhages with pale centers)
-splenomegaly
-digit clubbing
Pt is already taking penicillin for infection eradication. Alternatives? (2)
-Clindamycin, azithromycin, or clarithromycin
-Wait 10days after completion of antibiotics before administering