Getting to the root of his infection at National Heart Centre Singapore
Patient finds answer to his prolonged fever and treatment of heart infection
A heart problem is unlikely to come to most people’s minds when they have a fever. After all, a fever is a symptom of an infection in the body. But do you know that your heart can be infected too?
This was what Terry Leggett, an American working in Singapore, found out. In April 2009, he had a prolonged fever that lasted for close to two months. He was warded at a private hospital here for two weeks during which he was given heavy doses of antibiotics. The fever subsided but came back again after he went home. His regular doctor was not able to diagnose the cause of his fever.
So Mr. Leggett decided to consult Singapore General Hospital (SGH) and National Heart Centre Singapore (NHCS). SGH and NHCS are part of SingHealth, the largest public healthcare group in Singapore. Mr. Leggett is no stranger to Singapore’s healthcare services, having worked here since 1991. He had previously consulted doctors in private hospitals for various health reasons, including a stenting procedure for a blocked artery, done in 2006.
At SGH, he met Dr. Tan Ban Hock, head of infectious diseases at SGH, who told him, "I think the valve in your heart is damaged, and there is a 90 percent chance the infection is in your heart." Right away, he was warded in SGH where he went through a series of blood and ‘culture’ tests. Dr. Tan also referred him to Dr. Chua Yeow Leng, a senior consultant at NHCS for a heart diagnosis. At the NHCS, Dr. Chua referred Mr. Leggett for a TEE (Transesophageal echocardiogram), which is a test to detect infection of heart valves, and a MRI, which uses powerful magnets and radio waves to take pictures of the body.
The tests confirmed that he had infective endocarditis, an infection of either the heart lining or heart valves. In his case, it was an infection of the mitral valve, which is located between the left atrium and left ventricle of the heart. Because his valve was beyond repair, Dr. Chua advised him to go for a valve replacement (see below).
The surgery was a success and ended the nightmare for the Leggetts. His wife, Nora, was relieved. “I didn’t sleep much during this period, worrying about Terry and what was causing the fever. It was such a relief to finally know and be able to do something about it.”
Mr. Leggett was all praise for the care he received at NHCS. “Dr. Chua was open and honest about the risk of the operation. I really appreciate that. I am also amazed with Sister Yap Yen Ping, who is flexible and accommodating. She is a great nurse!” He added, “I received excellent treatment and service from the National Heart Centre Singapore, from the start to the end.”
What is infective endocarditis?
Infective endocarditis is an infection of the heart's inner lining (endocardium) or the heart valves caused by bacteria. We all have bacteria in our bodies, mostly found in the mouth, intestinal and urinary tracts, upper respiratory system and the skin. These bacteria can travel to the heart via the bloodstream but it rarely causes a problem to people with normal and healthy hearts.
Infective endocarditis is more common in people who have pre-existing heart conditions such as congenital heart defects, damaged heart valves, artificial heart valves or hypertrophic cardiomyopathy (enlarged or thickened heart walls). A sign of endocarditis is an unexplained and prolonged fever, usually over a few days. Other symptoms include fatigue, loss of appetite and/or weight loss, headache, inflammation of joints and a rash.
|
What is a mitral valve replacement?
A mitral valve, also called a bicuspid valve for its two flaps or leaflets, is located between the left atrium and left ventricle of the heart. It controls the flow of oxygenated blood from the lungs to the rest of the body. When the valve is badly damaged, surgery to repair or replace the valve is needed. Most of the valve repair or replacement surgery done by heart surgeons involves valves on the left side of the heart (such as the mitral and aortic valves) as the left side of the heart works harder than the right.
A mitral valve replacement, like an aortic valve replacement, is an open-heart surgery. It involves replacing a damaged mitral valve with a mechanical or biological one. Biological valves made from animals typically last 10 to 15 years before they need to be replaced. They have the advantage of not needing life-long blood thinning medication to prevent blood clots from forming on the valve surfaces. Mechanical valves, on the other hand, are extremely durable and can last up to 40 years. However, a patient fitted with a mechanical valve will need to take anti-coagulation (blood thinning) medicine for the rest of his or her life.
|
For more information about mitral valve replacement and other heart treatments, log on to www.nhcs.com.sg