Infective endocarditis … what you can do to avoid it

What is Endocarditis?

Patients with congenital heart disease are at increased risk of endocarditis, an infection of the inner lining of the heart.

It most commonly affects heart valves, but may also occur around holes in the heart, in major arteries, or at the site of previous keyhole or heart surgery.

Although it is uncommon, it is serious and can cause major problems, including stroke or death.

Treating endocarditis requires admission to hospital. Intravenous antibiotics (via a drip) are required, usually for six weeks and, in some cases, heart surgery is needed.

What are the symptoms of endocarditis

Patients with endocarditis develop a temperature and feel generally unwell, often with symptoms similar to having flu, such as:

High temperature
Shivering or chills
Fatigue
Night sweats
Loss of appetite and weight loss

Flu is very common and usually resolves after about 7-10 days.

Symptoms which persist for longer than this should be reported to your GP as well as your heart team.

How can I reduce the risk of getting endocarditis?

Endocarditis can only occur if bacteria get into the bloodstream (bacteraemia). Although it is not possible to prevent all bacteria getting into the bloodstream, there are some things you can do to reduce the risk.

Your teeth

Everybody carries bacteria in the mouth. They are usually harmless, but if the teeth or gums become diseased large numbers can enter the bloodstream. Good oral health is therefore particularly important in reducing the risk of endocarditis. You can help reduce the risk of endocarditis by:

Brushing your teeth twice a day, using fluoride toothpaste
Visiting your dentist for regular check-ups (every 6-12 months)
Eating a healthy diet, including reducing sugary snacks and fizzy drinks
Promptly attending a dentist with issues such as toothache or infection in the mouth
Have a dental check up prior to surgery

Endocarditis Prophylaxis for Dental Procedures

In line with the ESC Guidelines (2015) we would advise antibiotic prophylaxis in the event of any dental procedures requiring manipulation of the gingival or peri-apical region of the teeth or perforation of the oral mucosa if you fall into any of the following categories:

Previous endocarditis
A prosthetic valve replacement
Cyanotic heart disease
Implantation of prosthetic material for repair within the last 6 months

Should this apply to you, we advise a single dose of Amoxicillin 2g orally, or alternatively Doxycycline 100 mg orally (if Penicillin allergic), 30-60 minutes prior to the procedure. Please speak to your dentist to arrange this

Piercings, tattoos and other procedures

Procedures that break the skin such as body piercing, tattooing and cosmetic treatments, including microblading eyebrows, botox and dermal fillers can introduce bacteria into the blood
Patients at risk of endocarditis are best avoiding these procedures