Which of these is prone for infective endocarditis
Infective Endocarditis is prone to develop in lesions with a high-pressure gradient. High-velocity blood jet damages the endocardium leading the formation of nidus for infective endocarditis.
Atrial septal defect and mitral stenosis do not have a high-pressure gradient so they are not prone to infective endocarditis.
Mitral valve prolapse without mitral regurgitation is not associated with a higher risk of infective endocarditis
Patent ductus arteriosus is prone for infective endocarditis
Infective endocarditis vegetations develop on the area of blood hitting i.e in ventricular septal defect it is on the right ventricle, patent ductus arteriosus in the pulmonary artery, in coarctation of the aorta in post stenotic segment
Organisms causing Infective endocarditis
Three fourth of cases of infective endocarditis is caused by streptococci and staphylococci. Among the two staphylococci is more common now, from infection of skin, abscess and vascular access sites
The dental procedure may predispose by streptococci viridans because they are commensals in the oral cavity.
Strepto Milleri and Strepto Bovis infective endocarditis is associated with large bowel neoplasm
Enterococcus faecalis, Faecium and Strepo Bovis may enter the bloodstream leading infective endocarditis from urinary tract procedure
Apart from bacteria even fungi may also lead infective endocarditis
Patients who need infective endocarditis prophylaxis check this article
Patients with prosthetic valves (including transcatheter valves) and patients who have undergone valve repair in whom a prosthetic material is used.
Patients with a history of previous infective endocarditis.
Patients with cyanotic congenital heart defects.
Patients for the first six months after surgical or percutaneous repair of congenital heart disease with a prosthetic material (indefinitely in case of residual shunt or valvular regurgitation).
Dental procedure requiring infective endocarditis prophylaxis Check this article
Periodontal surgery, subgingival scaling, and root planing.
Replantation of avulsed teeth.
Other surgical procedures such as implant placement or an apicoectomy.
Dental procedures not requiring infective endocarditis prophylaxis
Local anesthetic injections.
Treatment of superficial caries.
Orthodontic appliance placement and adjustment.
Following shedding of deciduous teeth.
After lip or oral trauma.
Dukes Criteria for the diagnosis of infective endocarditis.
The typical organism from two cultures
Persistent positive blood cultures, taken from >12 hrs apart
Three or more positive cultures taken over > 1 hr
Positive echocardiographic findings of vegetations
New valvular regurgitation
Predisposing valvular or cardiac abnormality
Intravenous drug abuse
Pyrexia > 38 degree centigrade
Blood cultures suggestive of organisms grown but not achieving major criteria
Suggestive echocardiographic findings
Definite diagnosis = two major, or one major three minor criteria
Possible Endocarditis = One major with one minor criterion, or three minor criteria