NEET MDS

The Power Course

Which of these is prone for infective endocarditis



Choices

1 ) Patent ductus arteriosus
2 ) Mitral valve prolapse
3 ) Atrial septal defect
4 ) Mitral stenosis

Explanation


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


Answer

Patent ductus arteriosus

Further Reading


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

Tooth extraction.

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.

Dental X-rays.

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.

Major Criteria

The typical organism from two cultures

Persistent positive blood cultures, taken from >12 hrs apart

Three or more positive cultures taken over > 1 hr 

Endocardial involvement

Positive echocardiographic findings of vegetations

New valvular regurgitation

Minor Criteria

Predisposing valvular or cardiac abnormality

Intravenous drug abuse

Pyrexia > 38 degree centigrade

Embolic phenomenon

Vasculalitic phenomenon

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

 


Last Modified : 25-Dec-2019

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