Preventing Endocarditis

Please take a few minutes to consult the brochure entitled "Preventing Endocarditis".

What is endocarditis?

Endocarditis is an infection of the endocardium (internal heart membrane) or of the valves located inside the heart and the aorta (the main artery arising from the heart carrying oxygen-rich blood). This infection is caused most often by bacteria.

Bacteria normally found in certain areas of the body such as the mouth, the digestive tract and the skin, may enter the blood and eventually become lodged in the heart. This type of infection can damage the heart and even destroy the heart valves. Endocarditis is a rare but extremely serious condition requiring prolonged antibiotic treatment in hospital, and sometimes even an emergency operation. Endocarditis can even lead to death.

What persons are at risk of developing endocarditis?

People in good health have little risk of developing endocarditis. Persons with cardiac predispositions, however, run a higher risk of becoming infected by bacteria. You are at risk if you have:

• a congenital heart condition;
• a narrowing of the aorta;
• an artificial valve;
• a valve that is narrowed or leaking;
• hypertrophic cardiomyopathy;
• already had endocarditis in the past.

When can a person develop endocarditis?

When bacteria enter the bloodstream in a person at risk and then lodge in the heart. Some procedures lend themselves to bacteria entering the blood and are associated with a risk of endocarditis:

• dental procedure;
• digestive tract surgery;
• urinary tract surgery;
• childbirth;
• abortion.

Certain situations are also associated with a risk of endocarditis: skin infection, furuncle (boil), infected cut, infected acne and anything that produces pus. Cases of endocarditis have also been caused by tattooing and bodypiercing.

What are the symptoms of endocarditis?

If you are a person at risk, the symptoms of endocarditis are similar to those of a major and persistent flu. Patients usually present with fever (> 38 ^oC oral), which may be accompanied by fatigue, chills, joint pain, excessive perspiration, shortness of breath and headaches.

If you are at risk, it is important to consult your physician if your flu symptoms last longer than two or three days.

The only means of detecting endocarditis is to have a blood test called a hemoculture to check for the presence of bacteria in your blood.

If you are running a high fever and a physician wishes to prescribe antibiotics, you must insist on having a blood test (hemoculture). Checking for the presence of bacteria in the blood must be done before the start of treatment or the diagnosis could be delayed or difficult to establish.

What happens if you develop endocarditis?

You will have to be hospitalized and you will be given intravenous antibiotics for four to six weeks. In certain cases, heart surgery may be necessary to ensure complete recovery. If treatment is not started in a timely manner, you run the risk of developing complications affecting the brain, the kidneys, the blood vessels and the skin.

How can endocarditis be prevented?

It is essential to take antibiotics prior to every dental procedure. In working inside your mouth, the dentist may cause bacteria to enter the bloodstream, and antibiotics will protect you.

It is important to practise sound dental hygiene and to see your dentist annually for a check-up. Poor dental hygiene can increase the risk of bacteria entering the bloodstream every time you brush your teeth or chew.

It is also important to advise all of the physicians treating you that you are at risk of developing endocarditis.

If you need to have an operation, it is important to advise your surgeon that you normally take antibiotics before you visit the dentist. The surgeon will be able to tell you if you also need antibiotics before your operation.

If you are pregnant, you may need to take antibiotics at the time of delivery. This will not be harmful to the baby.

It is important to carry a card or wear a bracelet identifying your heart condition as well as the dosage of antibiotics necessary to prevent endocarditis. Ask your cardiologist to provide you with this card and present it every time you visit a physician or a dentist.