Endocarditis, caused second OHS in three years, age 64

[chuckdc37]

Well, like most OHS patients, warnings about endocarditis went in one ear and out the other. But of course I had to be attacked a "Rare" Strep Mitis bug that almost did me in!
This past December I thought I had the flu. The symptoms are almost identical. The thing is that for valve replacement folks, ANY temperature over 100 should be checked by your doctor and you need to be aware of of other telltale signs of endocarditis. Red splotches appear on your hands and things called spider slivers appear in your fingernails. And the aches and fatigue of endocarditis are much worse that the flu. (at least for me)Well I didn't get it diagnosed until Feb. and they put me on antibiotics for two weeks hoping to kill it and avoid surgery. That didn't do it so they operated on Mar. 23 and I'm here because of awesome skill and dedication of my doctors!
LOOK OUT FOR ENDOCARDITIS! Catch it early and avoid another OHS!

 

[normofthenorth]

Chuck, I think my cardiac center isn't even bothering with the IV antibiotics for AVR patients who get endocarditis any more!

Their 2010 study on 1134 recipients of "my" tissue valve has this to say:

There were 41 episodes of prosthetic valve endocarditis: 16 patients were treated surgically, and 1 died; 25 were treated medically, and 13 died during antibiotic treatment.
. . .
Patients with prosthetic heart valves have a low but constant risk of endocarditis. The freedom from endocarditis in this cohort was 94.5% +/- 1% at 20 years. Survival was poor if patients were treated with antibiotics alone. Most patients referred back to our institution had repeat operations, and only 1 of 16 died. During the past 2 decades, we have adopted an aggressive approach in the treatment of prosthetic valve endocarditis, but the outcomes remain largely dependent on the patient's clinical status when the operation occurs [11]

Adding a little interpretation of my own, it seems that many of UHN's (Toronto General Hospital's) AVR patients who got endocarditis went to different hospitals for treatment, and most of them got IV antibiotics, and about half of them died. But most of the ones that went back to UHN/TGH got surgery, and all but one of those survived. OHS is no picnic, of course, but as a treatment for endocarditis, it may well be "indicated", if these numbers are typical.

The main article's entitled "Hancock II Bioprosthesis for Aortic Valve Replacement: The Gold Standard of Bioprosthetic Valves Durability?" by Tirone E. David, MD, Susan Armstrong, MS, Manjula Maganti, MS, in Ann Thorac Surg 2010;90:775-781, abstract at ats.ctsnetjournals.org/cgi/content/abstract/90/3/775? .

Note 11 refers to a 2007 article on endocarditis in Thorac Cardiovasc Surg (133:144-9) by the same 3 authors plus 3 others including "my guy" (Dr. Feindel). It's at http://jtcs.ctsnetjournals.org/cgi/content/abstract/133/1/144 (abstract) and http://jtcs.ctsnetjournals.org/cgi/content/full/133/1/144 (full text). The articles listed at the bottom, at "This article has been cited by other articles", look fascinating. And the "Discussion" with Dr Steven W. Guyton (Seattle, Wash), at http://jtcs.ctsnetjournals.org/cgi/content/full/133/1/149, is also very interesting.

I'm having trouble reconciling the rosy surgical results (1 death in 16 cases) in the 2010 article, with the relatively bad surgical outcomes in the 2007 article.

 

[Lynlw]

I'm sorry to hear you had BE, I know how scarey that can be. Sorry they took so long to diagnosis it so you ended up needing surgery. Were you feeling sick the whole time from Dec to Feb when you were diagnosed and went to doctors all along or did you put off going to the doctor until then? I know it can be easy to think you have the flu or other kind of illness, since the symptons can be like so many other things. Justin had BE when he was 11 and it seemed like he had a resp infection, then stomache virus etc, that they thought he was just run down so was catching everything going thru the school. Luckily his was caught early enough they were able to just get rid of it with 6 weeks of IVs and no perm damage was done.

What a blessing they were able to diagnose your BE and you had a succesful surgery. Thanks for posting about it and reminding people its always something to keep in the back of your mind if you have some of the symptons.

 

[Greg a]

Well, like most OHS patients, warnings about endocarditis went in one ear and out the other. But of course I had to be attacked a "Rare" Strep Mitis bug that almost did me in!
This past December I thought I had the flu. The symptoms are almost identical. The thing is that for valve replacement folks, ANY temperature over 100 should be checked by your doctor and you need to be aware of of other telltale signs of endocarditis. Red splotches appear on your hands and things called spider slivers appear in your fingernails. And the aches and fatigue of endocarditis are much worse that the flu. (at least for me)Well I didn't get it diagnosed until Feb. and they put me on antibiotics for two weeks hoping to kill it and avoid surgery. That didn't do it so they operated on Mar. 23 and I'm here because of awesome skill and dedication of my doctors!
LOOK OUT FOR ENDOCARDITIS! Catch it early and avoid another OHS!

Great advice and yes it was one of the multitude of infections I fought four years ago

 

[catwoman]

My family doctor seems to be pretty cautious about endocarditis -- he's ordered blood cultures about 3 times post-op. Those bottles are as big as a beer bottle! :rolleyes2:

 

[New Guy]

Chuck.

Thank you for the reminder. I had forgotten how serious endocarditis is and am glad to learn from your experience. I made my wife read your post to save me from myself in the event I ever have this malady.

I hope you're well now.

 

[Bryan B]

I am not disputing any of the information here and I am only going by memory (I had endocarditis too) is that they prefer to try and get the endocarditis under control before operating. The vegetations on the valve are the main worry here because if any break off there is a high risk of stroke and death, and the leading cause of death from endocarditis is stroke. I am sure it is a tough call for a doctor to wait for the antibiotics to do their job or operate immediately. I still had my original valve so the risks may be different with a prosthetic valve. I was on IV antibiotics for 7 weeks and the vegetations cleared up but I still had surgery 3 months later, the only difference being that they didn't have to worry about the vegetations.