Infective endocarditis is the infection of the endocardium of the heart, the heart has three layers the pericardium, myocardium and the endocardium. The endocardium is the innermost layer of the heart and the infection may also involve the valves and septum. Two alterations in the body can lead to endocarditis; any changes in the cardiac endothelium that promotes attachment and bacteria circulating in the blood. The main culprits of this infection are Staphylococcus aureus, group b streptococcus.These bacteria may enter the blood stream due to poor dental hygiene, intravenous drug use, soft tissue infective or therapeutic procedures, invasive dental treatment like dental implant Cardigan, cardiac surgery or installment of pacemakers.The damaged endocardium lead to easy attachment of bacteria that may trigger an inflammatory reaction, and accumulation of white blood cells, platelets and fibrin which may gradually destroy the underlying structure and cause the pathologies which are septal defects, valvular disease. Aortic and mitral valves are the most commonly affected valve.
The clinical signs and symptoms present in a patient with infective endocarditis are, fever, blood in urine, new heart murmur, positive blood culture, Osler nodes (painful nodules found on the finger), Janeway lesions (non-painful nodules on palms and soles), Roth spots (hemorrhages in the retina). Some may show neurological deficits; embolic stroke that would result in neurological dysfunction and intracranial hemorrhage. It may also result in enlarged spleen, stiff neck, pallor and cardiac arrhythmias.
Diagnosis are extrapolated based on Dukes criteria which are further divided into major and minor, major being: obtaining a positive culture of the organism causing infective endocarditis in two different sample, persistent positive blood culture when the test is done 12 hours apart, evidence from the echocardiogram of the heart involvement, new valvular regurgitation and minor criteria: predisposition (having a heart condition) or using of intravenous drug, fever more than 38 degrees, signs like Janeway lesion, Osler node, hemorrhages in the retina, positive blood culture but does not fulfill major criteria as above and findings of the echocardiogram that may be present with infective endocarditis but does not meet the major criterion requirement.
Some of the preventive measures for endocarditis are: those susceptible to this disease before undergoing any dental procedure should be given an antibiotic prophylaxis, visiting the dentist for the monitoring of the condition of the mouth, addiction treatment for drug users.
When considering treatment, the condition that has to be paid attention are the elimination of the etiological agent and the consequences of the disease. Antibiotics are given to eradicate the microorganisms from the body, the treatment is given for 4- 6 weeks. Mild congestive heart failure can be treated with the conventional therapy. Surgery should be considered after careful consideration, that is taking into account the patients age, if he has any prosthetic implants or congestive heart failure, presence of infection around the valve or systemic embolization.