Why the guidelines were changed

The American Heart Association has long had guidelines for dealing with Endocarditis – a problem not faced by the majority of people, but threatening to those of us with Congenital Heart Defects (CHDs). Endocarditis can occur when bacteria in the blood settles on a damaged heart valve. This can cause an infection of the Endocardium (the inner lining of the heart) or can damage or destroy a heart valve.

For years the guidelines stated that if you had any kind of problem with your heart (defect, bypass surgery, had a valve replaced, etc.) you should take antibiotics to protect yourself from Endocarditis when you went to the dentist. But the guidelines have recently changed: Now, antibiotics are only recommended for certain people, and for certain procedures.

The guidelines have been changed because researchers have found that Endocarditis itself is changing. Studies in Europe have shown that the Antibiotics may not be that much of a preventative, and health care Endocarditis – Endocarditis caused by “in hospital contamination” – is rising. Also, surgery (if needed) is seen as being more effective the earlier it is done, so you need a whole team approach – Cardiologists, Cardiac Surgeons, Infective Disease Specialists, and a major cardiac surgical center, all working together.

One of the ways Endocarditis is diagnosed, especially if you have a medical device implanted in your body, is by Trans-Esophageal Echocardiography (TEE). It’s usually not pleasant: A tube with an ultrasound probe on the end is passed down your throat to give the doctors a good look at the heart from as close as possible. Ouch!

Mayo Clinic is working with new computer software to diagnose Endocarditis without the TEE. Designed to work like the human brain, the software literally has to be “taught” what to look for and how to respond. It’s complicated, but the software has made the correct diagnosis most of the time. (72 out of 73 times for all infections; and 12 of 13 Endocarditis cases in particular.)

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