The incidence of drug use-associated infective endocarditis has been increasing in direct correlation with the growth of the opioid epidemic.
When dentists hear the words infective endocarditis (IE), they often reflexively think of the same precaution: prophylactic antibiotics before dental treatment, 2g Amoxicillin or 500mg Clindamycin. IE is one of the few diseases our patients may develop following bacteremia from invasive dental procedures, but thankfully, its incidence is relatively rare.
Rising intravenous drug use has created new public health epidemics of hepatitis C and deadly bacterial infections.
Endocarditis is an uncommon but potentially deadly disease of the heart. Sometimes deemed a "silent killer," its early symptoms can be relatively mild, causing some people to delay seeking care. But not getting prompt treatment can lead to devastating consequences.
Two parallel studies find no increase in endocarditis incidence after invasive dental procedures, even among high-risk patients.
How many second chances should a drug user get? As many as it takes for us — physicians, society, government, and the healthcare system — to get it right.
Knowing symptoms + acting quickly could save your life.
A life-threatening heart infection afflicts a growing number of people who inject opioids or meth. Costly surgery can fix it, but the addiction often goes unaddressed.
A 52 year old woman is scheduled to undergo double valve replacement surgery for severe mitral stenosis and severe aortic regurgitation. She has no other comorbidities. As part of the routine preoperative evaluation a dental consultation is obtained. She is found to have dental caries in one premolar and the dentist advises extraction of the tooth. Would you advise periprocedural infective endocarditis prophylaxis?
Symptoms of endocarditis may develop slowly or suddenly. Fever, chills, and sweating are frequent symptoms. These sometimes can be present for days before any other symptoms appear. They can also come and go or be more noticeable at nighttime. You may also have fatigue, weakness, and aches and pains in the muscles or joints. Other signs can include:
•Small areas of bleeding under the nails (also known as splinter hemorrhages)
•Red, painless skin spots on the palms and soles (Janeway lesions)
•Red, painful nodes in the pads of the fingers and toes (Osler's nodes)
•Shortness of breath with activity
•Swelling of feet, legs, abdomen
We have long ago heard that gum disease may be linked to heart disease, but now due to recent discoveries made at the University of Rochester, there is even more evidence to shed light on why and how our oral health may affect the heart.
Acute Infective Endocarditis usually comes on suddenly and may become life-threatening within a matter of days. This type of Infective Endocarditis is usually caused by staphylococci, streptococci, pneumococci, or gonococci bacteria.
Generally, empiric therapy is not instituted in suspected cases of subacute endocarditis until the etiology is identified by blood cultures. If blood cultures are negative but endocarditis is still considered likely, therapy is chosen based on the most likely etiology. Acute endocarditis is usually due to Staphylococcus aureus infection (both methicillin-susceptible and methicillin-resistant), streptococci, and enterococci. Empiric therapy for such infections would generally be vancomycin until culture results become available.
The American Academy of Family Physicians is one of the largest national medical organizations, representing more than 94,000 family physicians, family medicine residents, and medical students nationwide. Founded in 1947, its mission has been to preserve and promote the science and art of family medicine and to ensure high-quality, cost-effective health care for patients of all ages.
Even though we were taught about Janeway lesions and Osler’s nodes in medical school, the reality is that these peripheral manifestations of endocarditis occur in only about 10% of patients. Listening for heart murmurs which are present in about 90% of patients with endocarditis is one of the most important physical exam maneuvers in patients who present with fever NYD.
endocarditis is a disease characterised by inflammation of the endocardium, typically affecting the heart valves and usually caused by infection and can be acute, subacute or chronic. most commonly affecting the aortic valve (previously mitral valve).
most cases of fulminant endocarditis are caused by S. aureus.
always suspect endocarditis in S. aureus septicaemia (perform TOE).
There appears to be a trend towards better outcomes when surgery is done instead of medical management.
In order for IE to occur you must have the triad of endothelial damage, platelet adhesion and microbial adherence.
Endocarditis is an infection of the heart valves and parts of the inside lining of the heart muscle (known as the "endocardium"). This is an uncommon, but not rare, infection. It is often very serious. The infection may begin at the time of a dental or medical procedure in someone who has a predisposing abnormality of their heart.
Mayo Clinic is a not-for-profit medical practice dedicated to the diagnosis and treatment of virtually every type of complex illness. Mayo Clinic staff members work together to meet your needs. You will see as many doctors, specialists and other health care professionals as needed to provide comprehensive diagnosis, understandable answers and effective treatment.
Endocarditis is an inflammation of your heart's inner lining. The most common type, bacterial endocarditis, occurs when germs enter your heart. These germs come through your bloodstream from another part of your body, often your mouth. Bacterial endocarditis can damage your heart valves. If untreated, it can be life-threatening. It is rare in healthy hearts.
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Infective endocarditis occurs worldwide, and is defined by infection of a native or prosthetic heart valve, the endocardial surface, or an indwelling cardiac device. The causes and epidemiology of the disease have evolved in recent decades with a doubling of the average patient age and an increased prevalence in patients with indwelling cardiac devices.