Infective Endocarditis

Infective Endocarditis (IE), also known as bacterial endocarditis (BE), is an infection typically caused by bacteria which enters the bloodstream and remain in the heart lining, blood vessel or heart valve. There are two categories of IE: acute IE and chronic IE. Acute IE is an infection that occurs suddenly and may worsen drastically within days. Meanwhile, chronic IE occurs over a few weeks or months. While it is an uncommon condition, patients with certain heart conditions have a higher risk of developing IE.

There are numerous symptoms of infective endocarditis (IE) and these may differ based on the cause of the infection and whether the patient has underlying heart problems. The common symptoms of IE include:

However, some patients might experience less common symptoms such as: 

There are a number of ways to prevent or reduce your risk of getting infective endocarditis (IE). 

If you experience any of the common symptoms of IE such as a persistent fever, unexplained tiredness or any wounds that do not heal properly, please see your doctor immediately. 

Brush and floss your teeth regularly and do not let gum disease go untreated. 

Dental Hygiene is important to prevent IE; please visit your dentist at least once a year.

If you have any cuts or grazes that show early signs of an infection, please wash them. If you begin to develop symptoms of a skin infection, please see your doctor immediately. Some of these symptoms include:

To avoid this, refrain from cosmetic procedures like piercings or tattoo that involve breaking the skin.

Prophylaxis (taking preventive antibiotics) against IE is recommended for the following patients with:

There is no evidence for endocarditis prophylaxis in gastrointestinal or genitourinary procedures unless there is active infection.

Any dental procedures that involve manipulation of gingival tissue, manipulation of the

periapical region of teeth, or perforation of the oral mucosa in patients.

Infective endocarditis (IE) is caused by germs that enter the bloodstream through a wide variety of ways. Bad oral hygiene, minor injury in the mouth or gums, implanted heart devices, and chronic skin disorders are some of the common ways bacteria enter the bloodstream.  

Certain risk factors can increase one’s chances of getting IE, including:

Diagnosis of infective endocarditis (IE) normally starts with a physical examination by a doctor, assessing your medical history and conducting routine tests. Other tests recommended may include:

If left untreated, infective endocarditis (IE) can result in life-threatening complications. As such, IE is typically treated with medication or surgical intervention.

Most people with infective or bacterial endocarditis can be treated with a high dose of antibiotics administered via an IV drip. Blood cultures will continue be taken throughout the patient’s stay in the hospital to monitor his/her symptoms and the treatment progress. When the symptoms have largely gone away, the patient might be discharged. However, the patient will have to continue with the IV antibiotics at home or with their doctor for several weeks. 

If IE is caused by a fungal infection, antifungal medication might have to be taken for life to prevent the infection from recurring. 

Surgical procedures might be required for those with severe IE infections or to replace a damaged heart valve. The key surgical procedures used to treat IE are valve repair/replacement, fluid or pus drainage, and repair of any unusual passageways (fistula) that have developed. Generally, surgery will be recommended to patients with the following:

Generally, the benefits of surgical intervention include:

Despite the benefits of surgical intervention for those with IE, this may not always be suitable. Those who are older, have chronic conditions or weaker immune systems might be unable to undergo surgery. Please speak with your doctor to discuss your suitability for these surgical procedures. 

Dental Surgeon / Doctor should confirm that the patient would / would not require antibiotic prophylaxis for dental extraction or operation.