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Infective Endocarditis

Infective Endocarditis: Symptoms, Causes and Risk Factors, Diagnosis, Treatments | National Heart Centre Singapore

Infective Endocarditis - What it is

​​​​​Infective Endocarditis (IE), also known as bacterial endocarditis (BE), is an infection caused by bacteria which enters the bloodstream and remain in the heart lining, a blood vessel or heart valve. While it is an uncommon condition, patients with certain heart conditions have a higher risk of developing IE, which may lead to other heart valve diseases.

Infective Endocarditis - Symptoms

​One may experience prolonged fever and chills as a symptoms of Infective Endocarditis.

Infective Endocarditis - How to prevent?

Prophylaxis against Infective Endocarditis is recommended for the following patients:
  • Prosthetic cardiac valves, including transcatherer implanted prostheses and homografts
  • Prosthetic material used for cardiac valve repair, such as annuloplasty rings and chords
  • Previous infective endocarditis 
  • Unrepaired cyanotic congenital heart disease or repaired congenital heart disease, with residual shunts or valvular regurgitation at the site of or adjacent to the site of a prosthetic patch or prosthetic device. 
  • Cardiac transplant with valve regurgitation due to a structurally abnormal valve.
There is no evidence for endocarditis prophylaxis in gastrointestinal or genitourinary procedures unless there is active infection.

Dental procedures for which endocarditis prophylaxis is recommended:
Any dental procedures that involve manipulation of gingival tissue, manipulation of the
periapical region of teeth, or perforation of the oral mucosa in patients.

Prophylactic Antibiotic Regimens:
  • ​Not allergic to penicillin
    • ​AMOXICILLIN 2 gm PO 1 hour before procedure
    Unable to take oral medication:
    • AMPICILLIN 2 gm IV or IM within 30 min before procedure
  • ​Allergic to penicillin ​
    • ​CLINDAMYCIN   600 mg PO or CEPHALEXIN 2 gm or AZITHROMYCIN / CLARITHROMYCIN 500 mg PO 1 hour before procedure
    ​Unable to take oral medication:​
    • CLINDAMYCIN 600 mg IV or CEFAZOLIN 1 gm IV or IM 30 min before procedure
* Cephalosporins should not use for patients with immediate hypersensitivity reaction to Penicillin
* IM indicates intramuscular; IV, intravenous and PO; by mouth
Dental Hygiene is important to prevent IE, please visit your dentist at least once a year.

Infective Endocarditis - Causes and Risk Factors

​Risk factors include prosthetic heart valves, intracardiac devices, diabetes mellitus, immunosuppression, intravenous drug use.

Infective Endocarditis - Diagnosis

Diagnosis normally starts with a physical examination by a doctor, assessing your medical history and routine tests. Other tests recommended may include:

Infective Endocarditis - Treatments

​Antibiotics can treat IE. For severe case, surgical intervention might be needed.

Infective Endocarditis - Preparing for surgery

Dental Surgeon / Doctor should confirm the following:
  • Patient would / would not require antibiotic prophylaxis for dental extraction or operation.
  • Patient is / is not on warfarin
  • To stop Tablet Aspirin / Ticlid 1 week before dental extraction or operation
  • ​Re-commence Tablet Aspirin / Ticlid once the risk of bleeding from the procedure/operation is over.

Infective Endocarditis - Post-surgery care

Infective Endocarditis - Other Information

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