Open Heart Surgery Graduate from Iowa in the United States

[pellicle]

So in layman’s terms it sounds like the irregular heartbeat causes turbulence which in turn causes the scarring which is what the bacteria is then able to grab hold to.

yes, that's my reading, although I'd say that some scarring will occur also when a valve (like a BAV) is sliced out and another valve stitched in too.

So if you didn't get an infection (say as Dick and a few others here did which was not caused by arrhythmia but did cause scarring on the leaflet / endocardium) before your OHS you may also be more prone to endocarditis just from the scar tissue of the valve surgery (I suspect that this is why there is disagreement / debate on the efficacy / need for antibiotics.

Personally, for myself, there is no debate. I take antibiotics prophylactic cover before dental work.

Pardon me, but I just wanted to toss in one more point: bacteria in the blood stream are sorted out pretty quick by the white blood cells (and other bits). Its when they move from free floating to attached (but not like a barnacle) that they can begin to form a film covering and you get endo.

Some good intro reading:

https://pubmed.ncbi.nlm.nih.gov/18827980/
https://link.springer.com/referenceworkentry/10.1007/0-387-30742-7_1
HTH

PS: Streptococcus is the most common bacteria in endo cases and its a prokaryotic bacteria.

 

[pellicle]

PPS: while backing out of my rabbit hole:

https://www.sciencedirect.com/science/article/pii/B9780323357753000102

Endocardium and Heart Valves​

The endocardium lines the myocardium and contains Purkinje nerve fibers, which transmit a rhythmic action potential throughout the myocardium leading to contraction. The endocardium is lined by endothelial cells, which modulate many aspects of normal hemostasis. In normal states, the endothelial cells are antithrombotic, preventing circulating cells from attaching and thus allowing normal flow of blood through the heart and blood vessels. The endocardium is continuous with the endothelium of blood and lymphatic vessels. Normal flow of blood through the heart depends on functional valves (see Chapter 2). Properly functioning valves serve as one-way valves, allowing blood either to flow from one chamber to another (through AVVs) or to exit from the heart and enter either the pulmonary circulation (pulmonic valve) or the systemic circulation (aortic valve).​

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2726828/

While such inflammation can be caused by a variety of disease states, the majority of endocarditis is caused by infectious agents.​

In my understanding here, the use of "disease states" would be the arrhythmia of which we started discussing...

Vegetation formation is a multistep process. The first step is endocardial injury, which may occur by many mechanisms. The most common mechanism is injury by turbulent blood flow from an acquired or congenital intracardiac abnormality. The most common site of such injury, and thus the most common site of vegetation formation, is on the line of closure of a valve surface, typically on the atrial surface of atrioventricular valves, or the ventricular surface of semilunar valves [2]. Alternatively, an intravascular catheter or other device may directly abrade the endocardium. In injection drug users, direct injection of contaminating debris may damage the tricuspid valve surface.​

Sorry, but I just wanted to refresh on stuff I haven't really dealt with in well over 20 years, so before I opened my keyboard I wanted to double check.

Ok ... night night

 

[QuincyRunner]

Excellent wrap up, which at least in my case answers all the remaining questions.

 

[carolinemc]

Yes, I would like clarification too. VitDoc acknowledged that turbulence "may" be a risk factor for valvular infection, although assuming that an irregular heartbeat contributes to turbulence then I think this is pretty well established. During turbulence the blood pools up while swirling in a heart chamber, typically the left Atrium, which makes it susceptible to infection since the bacteria is treading water so to speak. This is why the ADA for years required antibiotics before dental work for anyone with an irregular heartbeat, and still requires it for people with a mechanical heart valve (which creates turbulence) or anyone with a previous history of endocarditis.

Anyone with a heart issue, has to be dosed antibiotics for any cleaning or dental work to prevent encarditis. Been ADA Standard for many years.

 

[vitdoc]

Turbulence around a heart valve is predominantly from issues with the valve. Having a jet effect from a narrowed valve or turbulence from a mal formed valve are the likely leading associations. Irregular heart beat is NOT likely an issue.

 

[pellicle]

Turbulence around a heart valve is predominantly from issues with the valve. Having a jet effect from a narrowed valve or turbulence from a mal formed valve are the likely leading associations.

agreed

Irregular heart beat is NOT likely an issue.

so not Afib either?

 

[QuincyRunner]

VitDoc, if, as you say, an irregular heartbeat is not likely a risk factor for endocarditis, then there are an awful lot of dentists who should stop prescribing antibiotics for patients with an irregular heartbeat. I don’t know what kind of doctor you are but several cardiologists have told me that my endocarditis was likely the result of my having a preexisting heart murmur when I had dental work without any antibiotic cover. What am I missing here? And did you not read the links that Pellicle provided above?

 

[QuincyRunner]

And by the way, the turbulence and jets that were seen on an echo of my mitral valve did not appear until the infection had taken hold and the valve had begun to deteriorate, not before.