Bacterial
Endocarditis
Bacterial
endocarditis is an infection of the lining of
the heart. This infection can occur in any person
(infant, child, or adult) who has heart disease
present at birth (congenital heart disease), or
can occur in people without heart disease. Bacterial
endocarditis does not occur very often, but when
it does, it can cause serious heart damage. It
is very important to prevent this infection from
occurring, if possible.
Bacterial
endocarditis occurs when bacteria (germs) enter
the bloodstream and lodge inside the heart, where
they multiply and cause infection.
A normal
heart has a smooth lining, making it difficult
for bacteria to stick to it. However, persons
with congenital heart disease may have a roughened
area on the heart lining caused by pressure from
an abnormal opening or a leaky valve. Even after
surgery, roughened areas may remain due to scar
tissue formation or patches used to redirect blood
flow. These rough areas inside the heart are inviting,
opportune places for bacteria to build up and
multiply.
Bacteria
can enter the body in many ways. According to
the American Heart Association (AHA), some of
the most common ways include the following:
- dental procedures (including
professional teeth cleaning)
- tonsillectomy or adenoidectomy
- examination of the
respiratory passageways with an instrument known
as a rigid bronchoscope
- certain types of surgery
on the respiratory passageways, the gastrointestinal
tract, or the urinary tract
- gallbladder or prostate
surgery
Any
infant, child, or adult who has congenital heart
disease that has not yet been repaired can develop
bacterial endocarditis. Some people who have already
had a heart defect repaired may also need to take
precautions against bacterial endocarditis for
the rest of their lives, while others may no longer
need to observe these precautions. According to
the American Heart Association, heart problems
that put children at risk for developing bacterial
endocarditis include, but are not limited to,
the following:
- mitral valve prolapse
- an abnormality of the valve between the left
atrium and left ventricle of the heart that
causes backward flow of blood from the left
ventricle into the left atrium.
- prosthetic (artificial)
heart valves
- a previous history
of endocarditis (even in the absence of other
heart disease)
- complex cyanotic congenital
heart disease (due to insufficient oxygen in
the blood)
- surgically constructed
systemic pulmonary shunts or conduits
- uncorrected conditions
such as patent ductus arteriosus, ventricular
septal defect, primum atrial septal defect,
coarctation of the aorta, and bicuspid aortic
valve
- acquired valve dysfunction,
such as due to rheumatic heart disease or collagen
vascular disease
- hypertrophic cardiomyopathy
- enlarged heart muscle that causes impeded
blood flow.
Consult
your child's physician with any further questions
you may have about risk factors.
In addition
to a complete medical history and physical examination
of your child, diagnostic procedures may include:
- echocardiogram (echo)
- a procedure that evaluates the
structure and function of the heart by using
sound waves recorded on an electronic sensor
that produce a moving picture of the heart and
heart valves.
- complete blood count
(CBC) - a measurement of size, number,
and maturity of different blood cells in a specific
volume of blood.
- blood culture -
a test that assesses for and determines the
specific type of bacteria in the bloodstream,
if any.
Helping
your child maintain excellent oral hygiene is
an important step in preventing bacterial endocarditis.
Regular visits to the dentist for professional
cleaning and check-ups are essential. Proper oral
hygiene is crucial, including regular brushing
and flossing.
Prior
to procedures that put your child at risk, such
as those mentioned above, one dose of an antibiotic
is given. In most cases, the antibiotics can be
given by mouth instead of through a shot or an
intravenous (IV) line. Your child's dentist, pediatrician,
or cardiologist can give prescriptions for the
antibiotics to you.
Specific
treatment for bacterial endocarditis will be determined
by your child's physician based on:
- your child's age, overall
health, and medical history
- extent of the infection
- cause of the infection
- your child's tolerance
for specific medications, procedures, or therapies
- expectations for the
course of the infection
- your opinion or preference
Bacterial
endocarditis is serious. This infection can cause
severe damage to the inner lining of the heart
and to the valves. The infection can be treated
in most cases with strong antibiotics given through
an IV over the course of several weeks. However,
heart damage may occur before the infection can
be controlled. Consult your child's physician
for more information.
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