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5. When do you give prophylactic treatment in MVP?. Indication: patients with a prior history of endocarditis Treatment: Beta blockers M itral valve repair (or rarely, replacement) in severe MR Antiplatelet agents such as aspirin or anticoagulants such as warfarin.

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Indication:

    • patients with a prior history of endocarditis
  • Treatment:
  • Beta blockers
  • Mitral valve repair (or rarely, replacement) in severe MR
  • Antiplatelet agents such as aspirin or anticoagulants such as warfarin

Harrison’s Priciples of Internal Medicine, 17 ed.

when should patients with mitral valve proplase get endocarditis prophylaxis
When should patients with mitral valve proplase get endocarditis prophylaxis?

*Modified from Dajani et al, 1997

Triezenberg, D., et. al.,The Journal of Family Practice, “When should patients with mitral valve proplase get endocarditis prophylaxis?”, vol. 53, No. 3, March 2004. http://www.jfponline.com/Pages.asp?AID=1658

when should patients with mitral valve proplase get endocarditis prophylaxis1
When should patients with mitral valve proplase get endocarditis prophylaxis?

*Modified from Dajani et al, 1997

Triezenberg, D., et. al.,The Journal of Family Practice, “When should patients with mitral valve proplase get endocarditis prophylaxis?”, vol. 53, No. 3, March 2004. http://www.jfponline.com/Pages.asp?AID=1658

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News Releases: Most patients don't need antibiotics before dental procedures to prevent infective endocarditis

American Heart Association scientific statement

DALLAS, April 20:

  • “maintaining good oral health and hygiene appears to be more protective than prophylactic antibiotics”

http://americanheart.mediaroom.com/index.php?s=43&item=289

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News Releases: Most patients don't need antibiotics before dental procedures to prevent infective endocarditis

Patients at the greatest danger of bad outcomes from IE and for whom preventive antibiotics prior to a dental procedure are worth the risks include those with:

  • artificial heart valves
  • a history of having had IE
  • certain specific, serious congenital (present from birth) heart conditions, including

  –unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits

         –a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure

        –any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device

        –a cardiac transplant which develops a problem in a heart valve.

“Except for the conditions listed above, antibiotic prophylaxis is no longer recommended for any other form of congenital heart disease,”

http://americanheart.mediaroom.com/index.php?s=43&item=289

slide8
News Releases: Most patients don't need antibiotics before dental procedures to prevent infective endocarditis

The guidelines say patients who have taken prophylactic antibiotics routinely in the past but no longer need them include people with:

  • mitral valve prolapse
  • rheumatic heart disease
  • bicuspid valve disease
  • calcified aortic stenosis
  • congenital heart conditions such as ventricular septal defect, atrialseptal defect and hypertrophic cardiomyopathy.

“These patients still have a lifelong risk of IE,” Wilson* said.  “We’re just saying that the risk is much greater from a random blood-borne bacterial infection resulting from everyday activities than from a dental or medical procedure.”

  • The guidelines also do not recommend any prophylactic antibiotics to prevent IE for common gastrointestinal procedures or procedures on the urinary tract.  This holds true even for patients with the highest risk of bad outcomes from IE

*Walter R. Wilson, M.D., a professor of medicine at the Mayo Clinic in Rochester, Minn., and chair of the writing group

http://americanheart.mediaroom.com/index.php?s=43&item=289