Bacterial endocarditis?

[The mail man]

Hello everyone. I seem to read a lot about people here needing to go through surgery twice due to bacterial endocarditis setting in. How does one get it? Are there measures to prevent such a thing from happening? I did a Google search on this and didn't come up with much info except to not use illegal iv drugs (no problem there) and to keep good oral hygiene (got that down too). It looks like folks with either a mechanical or tissue valve can succumb to this thing. I'm not looking for something else to worry about but I like to keep my bases covered too.

Mail man

 

[Michelle]

Hi Mail Man,
My husband ended up with Bacterial Endocarditis after breaking a tooth while eating pumpkin seeds... essentially it allowed an infection to get into his blood stream and because he was born with a bi-cuspid instead of a tri-cuspid aortic valve ( We did not know this at the time) he was more susceptible to this... The valve was then damaged which let to his surgery and now I refer to him as bionic with he mechanical valve. In the past drug use was the only known cause but it has since been discovered that dental issues can cause it as well.. Your dentist should know if you have had valve replacement surgery! Hank takes an antibiotic 4 hours before any dental procedure now so that he wont have this problem again.

 

[dick0236]

.....it has since been discovered that dental issues can cause it as well.. Your dentist should know if you have had valve replacement surgery! Hank takes an antibiotic 4 hours before any dental procedure now so that he wont have this problem again.

Hi Mail Man
Although some valve patients develop endocarditis, I do not believe that endocarditis is a "given" major problem for those of us that have had OHS. Many/Most, including myself, have never experienced that problem. As Michelle posted....good dental hygene and care must be high on our list of necessary precautions to prevent additional heart problems. I also take 2000mg Amoxicillin(anti-biotic) before any "invasive" dental work.......although, for the my first +/- 20 years after OHS , it was not known that dental work bacteria could cause this problem and I never pre-medicated.....and I still never contracted endocarditis. Keep your mouth/teeth in good shape and take endocarditis off your "worry list". Stick around, you will find this forum invaluable.

 

[ski girl]

I'm one of the people who needed a redo due to endocarditis. Afterwards, my infectious disease doc told me some things I wish I had known before about oral hygiene. I've posted these before but they bear repeating:

Before you brush your teeth, rinse with antibacterial mouth wash, e.g. Listerine
Wait a few minutes, then brush
Floss with tape floss, not the string. Tape floss is somewhat flattened making it less likely that you will poke bacteria through.

The bacteria that I grew (7mm thick!) was a common mouth bacteria. I had had no dental issues and no memory of bleeding gums yet somehow the little buggers managed to get into my blood stream. The advice I was given about rinsing, waiting, tape floss is something we should all be doing, it's just so easy.

 

[pellicle]

Hi

I seem to read a lot about people here needing to go through surgery twice due to bacterial endocarditis setting in. How does one get it?

normally bacteria get into the blood, attach to the valve tissue in a location that enables them to thrive and hide from the red blood cells effectively and then multiply.

alternatively there is the possibility of getting an external to the blood stream (on the outer surface of the prosthetic)

Are there measures to prevent such a thing from happening?

mainly stuff for planning, you know, events which you can predict like going to the dentist. You can't really go around popping some amoxycilin every time time you suspect you've had 'a hull breach'

I was discussing with a nurse in ICU recently about this topic and she said that (recall I'm in Australia) compared to the UK (where she was from) there is very little endocarditis here. She put that down to the much better (by observation and smell) oral hygiene habits that Australians seem to have over the UK counterparts.

so cleaning and flossing your teeth may be an important factor in prevention too

 

[Agian]

So true Pellicle. Tasmania doesn't have fluoride in their water supply and it shows in their oral hygiene (according to a dentist I know). And yes, even English people acknowledge their bad teef. According to my reading, taking antibiotics before dental procedures can only prevent 10% of endocarditis. The advice is to have meticulous oral hygiene. Brushing and flossing twice a day, dentist every six months and following ski girl's advice. Endocarditis was a biggie for me in relation to needing a valve replacement, until I realised I've been at higher risk all my life anyway (Bicuspid valve). It appears that our mouths and what we put in them can get us in trouble. People have posted recently about problems they've had with alcohol and caffeine. Adventists live longer than everyone else: No cigs, no caffeine, no alcohol, vegetarian diet. I can live without coffee and alcohol; becoming a vego is a bit harder, when everything is meat and barbecues.

 

[The mail man]

Thanks for all the replies. Wow, this is some very good information. I am SO glad I came upon this excellent, informative site. Really, I had no idea just how important the oral hygiene thing was. I mean I regularly brush twice a day but am going to take it up a notch with the floss and mouth wash. The surprising thing is the fact that at no time did my cardiologist ,surgeon who replaced my valve, or my personal doc ever mention the importance of this. The only thing mentioned was if I was going to have any dental work done to let my dentist know ahead of time so he could prescribe some antibiotic for me. They should send a pamphlet home from the hospital on this subject in my opinion. By the way, I have a St Jude's mechanical carbon valve and am a Warfarin "lifer" now.

Mail man

 

[Luana]

One does not have to have had VR to get endocarditis. I had endocarditis long before VR. Endocarditis is most commonly caused by strep and staph, both of which are normal flora on skin. Anyone with a heart murmur can get endocarditis. Cause of mine was undetermined, but the bug was strep viridans.

 

[Gail in Ca]

I was quite naïve about BE after my 2 OHS. My doctors said to take antibiotics before going to the dentist to prevent it, and to take care of my teeth, which I had always done, so that was easy. I never thought about it because I did these preventatives and so I thought I was covered.
I got my endocarditis from staph. lugdunensis, a particularly nasty strain of staph. It lives on the skin of about 20% of the population.
I was misdiagnosed with the flu and sent home from an ER where I was visiting, and then, 2 days later from my own urgent care. I went back 3 days later and had so many things going wrong, from a brain bleed to high sed rate, lots of other tests out of range. This bacteria wanted to kill me!
I had very low hematocrit after being treated for 6 wks IV with 2 kinds of antibiotics. They knew my valves were involved and so I had my 3rd surgery just a few weeks after my treatment was finished. My mechanical valve was only 8.5 yrs old, but the surrounding tissue was damaged. It was replaced along with my old aortic graft and my mitral was able to be repaired. My infectious disease doc had no clue how I got it.
I wonder about the 1-2% that get it, when it seems like more than that have gotten it on this site. How many of the total members have had BE?

 

[canon4me]

I'm one of the people who needed a redo due to endocarditis. Afterwards, my infectious disease doc told me some things I wish I had known before about oral hygiene. I've posted these before but they bear repeating:

Before you brush your teeth, rinse with antibacterial mouth wash, e.g. Listerine
Wait a few minutes, then brush
Floss with tape floss, not the string. Tape floss is somewhat flattened making it less likely that you will poke bacteria through.

The bacteria that I grew (7mm thick!) was a common mouth bacteria. I had had no dental issues and no memory of bleeding gums yet somehow the little buggers managed to get into my blood stream. The advice I was given about rinsing, waiting, tape floss is something we should all be doing, it's just so easy.

GREAT advice! Thank you!

 

[canon4me]

In addition, I use a tongue scraper every morning to get rid of bacteria present on my tongue. I wonder if that creates more problems than it solves??

 

[Agian]

What on Earth made you think of getting a tongue scraper? :biggrin2:

 

[canon4me]

What on Earth made you think of getting a tongue scraper? :biggrin2:

Just one more step in eliminating bacteria on the tongue and preventing bad breath.

http://www.bewellwitharielle.com/be-well/daily-tool-of-the-day-tongue-scraper

I can provide you half a dozen reasons why I wear deodorant too if you like:biggrin2:

 

[tom in MO]

From what I've read, there has never been a case of endocarditis directly related to dental work. It's all guesswork. My GP, cardio and dentist agree on this as well. What is true is that bacteria that is often found in the mouth are common causes (not the only cause) of endocarditis. What is also true is that people with severe mouth problems also develop endocarditis from the mouth infection as well as infections in the lungs.

That's why the instructions change over the years. With my BAV, 20 years ago I was told to get on antibiotics for every cold and every dental procedure. Now I don't get any antibiotics for a cold and only dental procedures that will create blood (e.g. cleaning, but not filling a cavity) require antiobiotics.

Personally, I read ski girl's story before. I believe her specialist's logic and I use Listerine before and after I floss. She's right about flat tape as well. Before I go in for dental work, I take some with me and rinse my mouth out twice in the rest room. Why not kill the bugs before they have a chance to get in ya? I don't believe the antiobiotics are worth it, and they do strange things to my colon that I would prefer to avoid; thus I have skipped them for years when I had my BAV. However once I got my ticker I take them...you get a little more cautious

 

[Rachel]

After my surgery I used the Listerine as well - but it caused my gums to bleed. The dentist confirmed that I had a reaction to the Listerine. I now use a prescription mouthwash to kill the bacteria after I floss and brush.

Works for me

 

[Bryan B]

I had infective endocarditis before valve replacement. I probably would have needed VR at some point in my life but the IE sped that process up. I was born with a large VSD which grew smaller but never closed. It was causing one of the leaflets on my aortic valve to prolapse, and this is where the infection colonized. I had bronchial pneumonia / chronic bronchitis in early July of 2003 and I was finally diagnosed with endocarditis in late October. My infectious disease doc couldn't say with 100% certainty that the lung infection was the cause but he said it was the likely cause. I really haven't done much different since I got endocarditis other than be more aware of the initial symptoms and not take them lightly. Obviously dental hygiene is important to me but I think there is only so much you can to to prevent the infection and much of it is out of my control.