Heart Valve Infections

March 28, 2007

A while back many of us were discussing heart problems. I found this

article very interesting, especially since Sharon's ECG showed 3

areas of the heart with regurgitation. The doctor said it was a

normal ECG, but the report states abnormal.

KC

Heart Valve Infections

http://jama.ama-assn.org/cgi/content/full/297/12/1396

Heart valves allow one-way flow of blood through the heart. Damaged

heart valves that do not open completely (called stenosis) or close

completely (called regurgitation) are susceptible to infection

because they cause abnormal blood flow through the valve. Infections

of heart valves (known as endocarditis) are serious and can be life-

threatening. The most common heart infections are caused by

bacteria, though fungal infections can also occur. Prosthetic

(replaced) or repaired heart valves are prone to infection. Growths

of infectious tissue on heart valves are called vegetations and can

lead to strokes due to pieces of tissue breaking off (called emboli)

and blocking blood vessels in the brain. The March 28, 2007, issue

of JAMA includes an article on infections of prosthetic heart

valves.

RISK FACTORS

Damaged or abnormal heart valves

Prosthetic heart valves

Intravenous illegal drug use causing heart valve damage from foreign

substances and infectious agents injected into the bloodstream

Indwelling medical equipment such as intravascular catheters,

pacemakers, and defibrillators serving as an entry point for

bacteria

SIGNS AND SYMPTOMS

Fever

Back, joint, or muscle aches

Shortness of breath

Fatigue

Unusual rash or spots on skin

DIAGNOSIS AND TESTING

In addition to asking questions about your history and doing a

physical examination, your doctor may order blood tests looking for

anemia or an increased white blood cell count, which indicates

infection. Blood may be sampled and cultured, looking for bacteria

in the bloodstream. An echocardiogram (an ultrasound examination of

the heart) can show abnormal blood flow through the heart or damage

to the valves or heart chambers. Echocardiograms are also useful to

diagnose serious complications of endocarditis, such as an abscess

(a pocket of infection) and regurgitation.

TREATMENT

Antibiotics are selected based on what type of bacteria or fungus

grows in laboratory studies. Because heart valve infection is

serious, treatment with intravenous antibiotics for a prolonged

period of time (usually 4 to 6 weeks) may be necessary.

Surgery may be needed to repair or replace the damaged valve.

If you have an abnormal or prosthetic heart valve, your doctor may

recommend antibiotic therapy before dental procedures or other

invasive treatments to prevent bloodstream infections.

FOR MORE INFORMATION

American Heart Association

http://www.americanheart.org

National Heart, Lung, and Blood Institute

http://www.nhlbi.nih.gov

INFORM YOURSELF

To find this and previous JAMA Patient Pages, go to the Patient Page

Index on JAMA's Web site at http://www.jama.com. Many are available

in English and Spanish. A Patient Page on endocarditis was published

in the July 3, 2002, issue.

Sources: National Heart, Lung, and Blood Institute; American Heart

Association; Centers for Disease Control and Prevention

The JAMA Patient Page is a public service of JAMA. The information

and recommendations appearing on this page are appropriate in most

instances, but they are not a substitute for medical diagnosis. For

specific information concerning your personal medical condition,

JAMA suggests that you consult your physician. This page may be

photocopied noncommercially by physicians and other health care

professionals to share with patients. To purchase bulk reprints,

call 203/259-8724.

TOPIC: HEART DISEASE

Janet M. Torpy, MD, Writer; Alison E. Burke, MA, Illustrator;

M. Glass, MD, Editor

JAMA. 2007;297:1396.

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