Bacterial Endocarditis
What is bacterial endocarditis?Bacterial endocarditis is an infection of the lining of the
heart. This infection can occur in any person (infant, child, or adult)
who has heart disease present at birth (congenital heart disease), or can
occur in people without heart disease. Bacterial endocarditis does not
occur very often, but when it does, it can cause serious heart damage. It
is very important to prevent this infection from occurring, if possible.
How does the infection occur?Bacterial endocarditis occurs when bacteria (germs) enter the
bloodstream and lodge inside the heart, where they multiply and cause
infection.
A normal heart has a smooth lining, making it difficult for bacteria to
stick to it. However, persons with congenital heart disease may have a
roughened area on the heart lining caused by pressure from an abnormal
opening or a leaky valve. Even after surgery, roughened areas may remain
due to scar tissue formation or patches used to redirect blood flow. These
rough areas inside the heart are inviting, opportune places for bacteria
to build up and multiply.
How does the bacteria get inside the body?Bacteria can enter the body in many ways. According to the
American Heart Association (AHA), some of the most common ways include the
following:
- dental procedures (including professional teeth cleaning)
- tonsillectomy or adenoidectomy
- examination of the respiratory passageways with an instrument known
as a rigid bronchoscope
- certain types of surgery on the respiratory passageways, the
gastrointestinal tract, or the urinary tract
- gallbladder or prostate surgery
Who is at risk for bacterial endocarditis?Any infant, child, or adult who has congenital heart disease
that has not yet been repaired can develop bacterial endocarditis. Some
people who have already had a heart defect repaired may also need to take
precautions against bacterial endocarditis for the rest of their lives,
while others may no longer need to observe these precautions. According to
the American Heart Association, heart problems that put children at risk
for developing bacterial endocarditis include, but are not limited to, the
following:
- mitral valve prolapse - an abnormality of the valve between the left
atrium and left ventricle of the heart that causes backward flow of
blood from the left ventricle into the left atrium.
- prosthetic (artificial) heart valves
- a previous history of endocarditis (even in the absence of other
heart disease)
- complex cyanotic congenital heart disease (due to insufficient
oxygen in the blood)
- surgically constructed systemic pulmonary shunts or conduits
- uncorrected conditions such as patent ductus arteriosus, ventricular
septal defect, primum atrial septal defect, coarctation of the aorta,
and bicuspid aortic valve
- acquired valve dysfunction, such as due to rheumatic heart disease
or collagen vascular disease
- hypertrophic cardiomyopathy - enlarged heart muscle that causes
impeded blood flow.
Consult your child's physician with any further questions you may have
about risk factors.
How is bacterial endocarditis diagnosed?In addition to a complete medical history and physical
examination of your child, diagnostic procedures may include:
- echocardiogram (echo) - a procedure that evaluates the
structure and function of the heart by using sound waves recorded on an
electronic sensor that produce a moving picture of the heart and heart
valves.
- complete blood count (CBC) - a measurement of size, number,
and maturity of different blood cells in a specific volume of blood.
- blood culture - a test that assesses for and determines the
specific type of bacteria in the bloodstream, if any.
How is bacterial endocarditis prevented?Helping your child maintain excellent oral hygiene is an
important step in preventing bacterial endocarditis. Regular visits to the
dentist for professional cleaning and check-ups are essential. Proper oral
hygiene is crucial, including regular brushing and flossing.
Prior to procedures that put your child at risk, such as those
mentioned above, one dose of an antibiotic is given. In most cases, the
antibiotics can be given by mouth instead of through a shot or an
intravenous (IV) line. Your child's dentist, pediatrician, or cardiologist
can give prescriptions for the antibiotics to you.
Treatment for bacterial endocarditis:
Specific treatment for bacterial endocarditis will be determined by your
child's physician based on:
- your child's age, overall health, and medical history
- extent of the infection
- cause of the infection
- your child's tolerance for specific medications, procedures, or
therapies
- expectations for the course of the infection
- your opinion or preference
Bacterial endocarditis is serious. This infection can cause severe
damage to the inner lining of the heart and to the valves. The infection
can be treated in most cases with strong antibiotics given through an IV
over the course of several weeks. However, heart damage may occur before
the infection can be controlled. Consult your child's physician for more
information.
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Heart Conditions in Children