Endocarditis is an uncommon, potentially fatal infection of the heart muscle's lining and valves. Infective endocarditis is caused by a bacterial infection. Although it may happen to anybody, persons with particular cardiac diseases and those who have had it before are higher risk patients. You can take efforts to reduce your risk if you have underlying factors.
WHAT IS ENDOCARDITIS?
Infective endocarditis is a potentially fatal inflammation of the lining of the heart's chambers and valves. The endocardium is the name given to this lining.
In most cases, endocarditis is caused by an infection. Bacteria, fungus, and other pathogens enter the circulation and attach themselves to damaged parts of the heart. Endocarditis is more likely if you have artificial heart valves, damaged heart valves, or other heart defects.
Endocarditis can damage or destroy heart valves if not treated promptly. Endocarditis is treated with medicines and surgery.
Endocarditis symptoms vary from person to person. Endocarditis can appear gradually or unexpectedly. It is determined by the type of bacteria producing the illness as well as the presence of other cardiac issues.
Endocarditis is characterized by the following symptoms:
- Muscle and joint pain
- When you breathe, you feel discomfort in your chest
- Flu-like symptoms, including fever and chills
- Sweating at night
- Breathing difficulty
- Swelling of the feet, legs, or abdomen
- A fresh or altered heart whooshing sound (murmur)
Endocarditis symptoms that are less prevalent include:
- Unknown cause of weight loss
- Urine with blood
- Tenderness in the area of the left rib cage (spleen)
- Painless red, purple, or brown flat areas on the soles or palms of the feet or hands (Janeway lesions)
- Painful red or purple pimples or darker skin patches (hyperpigmentation) on the tips of the fingers or toes (Osler nodes)
- Petechiae are little purple, red, or brown spherical spots on the skin, on the whites of the eyes, or within the mouth
CAUSES OF HEART INFECTION AND CONGENITAL HEART DISEASE
Endocarditis occurs when bacteria or fungi enter the body as a result of an infection, or when typically innocuous bacteria found in the mouth, upper respiratory system, or other regions of the body attack heart tissue.
The immune system normally destroys these unwelcome microorganisms, but any damage to the heart valve allows them to adhere to the heart and grow. There are several ways this can happen including:
- On the heart valve, clumps of bacteria and cells, or vegetation, develop. These aggregates make it difficult for the heart to function correctly.
- They can induce heart valve and heart muscle abscesses, tissue damage, and electrical conduction problems.
- A clump may break off and spread to other organs, including the kidneys, lungs, and brain.
- Invasive dental procedures or conditions or surgery that causes an infection might set it off. Poor dental or gum health also causes a higher risk of endocarditis because it allows germs to enter the body more easily through bleeding gums. Good dental hygiene can help keep your heart healthy.
- Other surgical and dental procedures, such as examinations to inspect the digestive tract, including a colonoscopy, might allow germs to enter. Procedures affecting the respiratory tract, the urinary tract (containing the kidneys, bladder, and urethra), the skin, bones, and muscles are also high risk.
- If germs enter the body in someone with a cardiac defect, there can also be a risk of getting endocarditis. This might be due to a congenital abnormality, an aberrant cardiac valve, or damaged heart tissue. People who have an artificial heart valve or cardiovascular disease are more vulnerable.
- A bacterial infection in another region of the body, such as a skin sore or oral bacteria from gum disease might cause germs to spread. Injecting narcotics with dirty needles is also dangerous. Anyone suffering from sepsis is at risk of developing endocarditis.
- Sexually transmitted diseases (STIs) like chlamydia and gonorrhea make it simpler for germs to enter the body and reach the heart.
- Endocarditis can be caused by a candida fungal infection.
- Inflammatory bowel disease (IBD) or other intestinal problems may potentially raise the risk, but the likelihood of getting endocarditis in someone with IBD is still minimal.
- The use of surgical or medical procedures in therapy, such as a urinary catheter or long-term intravenous medicine, can also raise the risk.
WHEN SHOULD YOU SEE A DOCTOR?
If you experience endocarditis symptoms, consult your doctor as soon as possible, especially if you have a congenital heart defect or a history of endocarditis. Similar signs and symptoms may be caused by less serious complications. To make the diagnosis, a proper assessment by a health care practitioner is required.
Tell your internal medicine doctor or even heart specialist if you've been diagnosed with endocarditis and have any of the following symptoms. These symptoms may indicate that the infection is progressing:
- Shortness of breath
- Joint discomfort
DENTAL CARE FOR PEOPLE WITH HEART DISEASE
When it comes to dental care, those with heart disease have unique requirements. If you have one of the following cardiac diseases, here are some health tips to think about before going to the dentist:
DENTAL CARE FOLLOWING A HEART ATTACK
If your cardiologist recommends it, discuss any dental procedures with them. Also, inform your dentist if you are on anticoagulants (blood-thinning drugs). These drugs may cause excessive bleeding during certain oral surgical procedures. Inquire with your dentist about the availability of oxygen and nitroglycerin in the event of a medical emergency during your office visit.
EXCESSIVELY HIGH BLOOD PRESSURE (HYPERTENSION)
Some antihypertensive medications might produce dry mouth or change your sensation of taste. Calcium channel blockers, in particular, can cause gum tissue to enlarge and overgrow, causing chewing problems. If you do have gum overgrowth, your dentist may offer you thorough oral hygiene advice and may require you to visit the dentist more frequently for cleanings. Gingivectomy, or gum surgery to remove extra gum tissue, may be required in rare instances.
If you need anesthetic for a dental treatment, ask your dentist if the anesthetic contains epinephrine. Epinephrine is a frequent ingredient in local anesthetics. In certain people with high blood pressure, the use of epinephrine may result in cardiovascular abnormalities. This may include rapid development of extreme high blood pressure, heart attack, angina, and arrhythmias, and should be taken with caution.
CHEST PAIN (ANGINA)
Calcium channel blockers may cause gum overgrowth in patients with angina. Gum surgery may be required in rare circumstances.
Patients with angina, such those who have had a previous heart attack, should ask their dentist if oxygen and nitroglycerin are accessible in case of a medical emergency.
While patients with stable angina can have any dental procedure done, patients with unstable angina should not have any dental procedures done, and emergency dental care should be done in a hospital or office that has cardiac monitoring capability.
Whether you've previously had a stroke, notify your dentist if you're taking anticoagulants. These drugs may cause excessive bleeding during certain oral surgical procedures.
If your stroke has damaged your capacity to create enough saliva, your dentist may advise you to use artificial saliva. If your stroke has impacted your face, tongue, or dominant hand and arm, your dentist may also advise you to use fluoride gels, modified brushing or flossing techniques, additional rinsing, and measures that others may use to help you maintain excellent dental hygiene.
HEART FAILURE AND ORAL HEALTH
Some heart failure drugs (such as diuretics, or water tablets) can induce dry lips. Inquire with your dentist about dry mouth treatments, such as the use of artificial saliva.
CONSIDERATIONS FOR DENTAL CARE AND HEART DISEASE
Give your dentist a detailed list of all the medications you are taking for your heart problem, including the names and doses as well as any other medications that you may be taking. This will assist your dentist in determining the optimal treatment plan for you, including the drugs to be used during dental treatments.
Give your dentist your doctor's name and phone number in case your dentist wants to communicate with them regarding your treatment.
If you are concerned about getting a dental operation due to your heart disease, consult with your dentist and heart doctor. Your physicians can offer you information and work with you to develop techniques for managing oral pain and reducing anxiety.
WARNINGS AND RISK FACTORS WHEN GETTING DENTAL PROCEDURES
People who have had heart valve disease or surgery, congenital heart disease, or recurrent infective endocarditis are more likely to have problems if they get IE. Using drugs through an IV also makes you more likely to get IE. Viridans group streptococcal infective endocarditis (VGS IE) is caused by bacteria that gather in plaque on the surface of the tooth and make the gums red and swollen. Some people have worried that certain dental procedures might make it more likely for vulnerable patients to get VGS IE.
New guidance as of 2021 from the American Heart Association confirms prior recommendations: Only four types of heart patients should be given antibiotic treatment before certain dental procedures to prevent VGS IE because they are more likely to get sick from it:
- People with prosthetic heart valves or prosthetic materials used to fix valves
- People who have had infective endocarditis before
- Adults and children with congenital heart disease
- People who have had a heart transplant
Since the 2007 AHA guidelines, research has shown that the limited use of preventive antibiotics for dental procedures hasn't led to more cases of endocarditis. This is an important step toward stopping the overuse of antibiotic treatment in the general population.
WHAT DENTAL PROCEDURES SHOULD PREVENTIVE ANTIBIOTICS BE USED FOR?
The updated recommendations recommend preventative therapy for all patients with the aforementioned cardiac problems, but not for all dental treatments.
The only treatments for certain dental procedures with preventive antibiotics are recommended by the guidelines when the interior lining of the mouth is perforated during dental treatments that require manipulation of gingival tissue (around bone and teeth) or the periapical area of teeth (tip of the tooth root).
Preventive antibiotics are not recommended for the following dental treatments or occurrences, according to the guidelines:
- Injections of anesthetics into noninfected tissue on a regular basis
- Dental radiographs
- Placing removable orthodontic or prosthodontic appliances
- Orthodontic appliance repositioning
- Placing orthodontic brackets
- Baby teeth falling out
- Bleeding caused by injuries to the lips or the interior of the mouth
IS THERE ANYTHING ELSE I CAN DO TO REDUCE MY BACTERIAL ENDOCARDITIS RISK?
If your health has changed since your last appointment, notify your dentist. If you've undergone heart or vascular surgery within the last six months, also tell your dentist. Please also include any additional cardiac issues that you have been diagnosed with.
Make sure your dentist has a thorough list of the names and doses of all your prescription and over-the-counter drugs. Make sure your dentist also has all of your physicians' names and phone numbers. Your dentist may wish to discuss your dental care plan and prescription options with your doctor.
Maintain proper dental health and care excellence and practice good oral hygiene. Brush your teeth at least twice a day, floss once a day, and rinse with an antimicrobial mouthwash once a day. Patients at risk for endocarditis must maintain good oral and dental health to prevent life threatening inflammation.
Endocarditis is usually lethal if left untreated, although most people survive if treated early with antibiotics.
However, it can still be lethal in the elderly, those with underlying conditions, and those infected with a resistant form of bacteria.
The National Heart, Lung, and Blood Institute (NHLBI) recommends that people at risk of endocarditis get frequent dental examinations and clean and floss their teeth on a regular basis.
Since 2007, the American Heart Association (AHA) has advised those who are at high risk of endocarditis to receive antibiotics prior to having some dental work done.
CAN DENTAL WORK CAUSE HEART INFECTION?
Infective endocarditis is a severe infection that affects the endothelial surfaces of the heart, particularly the valves. The main causative agents in this illness are oral commensal bacteria. Common dental operations, especially non-surgical dental procedures, can frequently result in oral commensal bacteremia.
HOW COMMON IS ENDOCARDITIS AFTER DENTAL WORK?
A limited number of people develop bacterial endocarditis as a result of dental treatment. Bacterial endocarditis occurs in 1 out of every 3000 individuals with valve disease.
HOW LONG AFTER DENTAL CLEANING CAN YOU GET ENDOCARDITIS?
The majority of procedure-related endocarditis cases develop within two weeks following the surgery.
WHAT IS THE MOST COMMON CAUSE OF INFECTIVE ENDOCARDITIS AFTER DENTAL PROCEDURE?
Staphylococcus aureus is the most common cause of bacterial endocarditis in the first 6 months (Staph infection).