Cardiology Flashcards
Including infective endocarditis
Which heart valves are most likely to have problems?
Mitral and aortic - they undergo the most pressure (left valves)
What are 2 types of valve problems?
Valve stenosis - valve narrowing
Valve incompetence - where valves are unable to shut properly
What causes valve disease?
Congenital abnormality - aortic valve should be tricuspid but a common defect is BICUSPID AORTIC valve - do not function correctly.
MI - can rupture papillary muscles
Rheumatic fever
How can rheumatic fever cause infective endocarditis?
RF is an immunological reaction that can cause damage to the heart valve. Rheumatic heart disease can cause vegetations to develop on the valves which can leaf to IE.
What type of heart valve replacement is at higher risk of infective endocarditis?
Mechanical
How can a patient reduce their risk of getting infective endocarditis/ prevention advice for a patient?
Importance of having good OH
Regularly see your dentist
Advise about symptoms of infective endocarditis
The risks of undergoing invasive procedures - including non-medical procedures such as body piercing or tattooing
Symptoms of infective endocarditis?
High temperature above 38
Sweats or chills
Breathlessness
Weight loss
Fatigue
Muscle, joint or back pain
Particularly if combined with flu-like illness
Who is at risk of infective endocarditis?
Heart valve disease
Replacement/ prosthetic heart valve
Hypertrophic cardiomyopathy - thickening of the heart walls
Previous history of IE
Congenital heart disease
Rheumatic heart disease
What is the ROUTINE management for antibiotic prophylaxis for those at increased risk of infective endocarditis?
NO ANTIBIOTIC PROVIDED will be appropriate for most patients at increased risk of infective endocarditis.
Ensure patient/ carer are aware of risk of IE and provide prevention advice
Record discussion in notes
Ensure any episodes of dental infection in patients at increased risk of infective endocarditis are promptly investigated and treated
What should you do as the clinician if your patient at increased risk of infective endocarditis, but would not ROUTINELY be offered Ab, requests antibiotic prophylaxis prior to invasive dental treatment?
Consider seeking advice from their cardiology consultant/ surgeon
What are the sub-group of patients requiring special consideration?
Prosthetic heart valve
Previous IE
Any type of cyanotic congenital heart disease
Any type of congenital heart disease repaired with a prosthetic material
Give examples of INVASIVE dental procedures?
Placement of matrix bands
Placement of sub-gingival rubber dam clamps
Endo treatment before apical stop has been established
Preformed metal crowns
Perio pocket charting (excludes BPE)
Sub-gingival pmpr
Incision/ drainage abscesses
Extractions
Raising a flap
Implant surgery
What is an appropriate dose of oral regimen of antibiotic prophylaxis for IE for adults?
Amoxicillin
Give 3g (1 sachet)
60 minutes before procedure
What is an appropriate dose of oral regimen of antibiotic prophylaxis for an adult for IE that is allergic to penicillin?
Clindamycin capsules 300mg
Give 600mg - 2 tablets
60 minutes before procedure
What are the potential risks of antibiotic prophylaxis for IE?
Associated with rise in clostridium difficile-associated disease/ infection
Antibiotic resistance
