According to the guidelines from the European Society of Cardiology (ESC) on infective endocarditis, patients with specific cardiac conditions like valvular heart disease, congenital abnormalities, or those requiring pacemakers should prioritize good dental and skin hygiene. This is crucial to prevent rare but potentially fatal infections of the heart’s inner lining and valves.

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Infective endocarditis is a serious and uncommon disease that can manifest with various symptoms, making diagnosis challenging. Professor Michael Borger from Leipzig Heart Centre, Germany, the chairperson of the Guidelines task force, emphasizes the importance of patient education for early detection and treatment. Individuals with valvular heart disease or prior heart valve surgery should be especially vigilant in terms of prevention and recognizing symptoms.

Infective endocarditis refers to an infection of the heart’s inner lining, typically involving the heart valves. It can occur when germs or fungi enter the bloodstream after surgeries, dental procedures, or skin issues. Symptoms may include fever, night sweats, weight loss, cough, disorientation, and fainting. This condition can lead to valve damage, abscesses, and the formation of clusters of cells and microbes that can break into smaller pieces and spread to other parts of the body (embolization). Complications like heart failure, septic shock, and stroke are also possible.

The guidelines underscore that prevention is the key, especially in high-risk patients. Patients at high risk include those with previous infective endocarditis episodes, prosthetic heart valves, congenital heart disease (excluding isolated congenital heart valve abnormalities), or a left ventricular assist device. In such cases, prophylactic antibiotics are recommended before dental procedures. Patients at intermediate risk, like those with pacemakers, severe valvular heart disease, congenital heart valve abnormalities, or hypertrophic cardiomyopathy, should have the need for antibiotic prophylaxis evaluated on an individual basis. Antibiotic prophylaxis is not necessary for those at low risk.

The guidelines recommend additional preventive measures for high and intermediate-risk patients, such as regular tooth cleaning, professional dental cleanings, consulting a doctor for unexplained fever, strict skin hygiene, addressing chronic skin conditions, and wound disinfection. Recommendations are provided for diagnosis, treatment, and managing complications. Diagnosis involves clinical suspicion, blood cultures, and imaging. Echocardiography is the primary imaging technique, with new diagnostic criteria including findings from other imaging methods.

Treatment aims to cure the infection and preserve heart valve function. Appropriate antibiotics based on blood cultures are the mainstay, with the duration dependent on infection severity. Surgery is necessary for patients with heart failure or uncontrolled infection to remove infected material and drain abscesses, thereby preventing embolization. The guidelines also address the timing of surgery in patients who have suffered a stroke, balancing the risks of surgical therapy against neurological deterioration.

Patient-centered care and shared decision-making are emphasized in the guidelines, recognizing that infective endocarditis is a life-threatening condition with significant physical and emotional impacts on patients and their families.

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