Aortic regurgitation precautions: Difference between revisions

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{{Aortic insufficiency}}
{{Aortic insufficiency}}
{{CMG}}; {{AOEIC}} {{VK}}, {{LG}}, [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@wikidoc.org]  
{{CMG}}; {{AOEIC}} {{VK}}; {{LG}}; [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@wikidoc.org]  


==Precautions==
==Overview==
People with aortic insufficiency of any aetiology are at risk for the development of infection of their damaged valve, i.e. [[infective endocarditis]]. To lessen the chance of developing that serious complication, people with AI are usually advised to take antibiotic prophylaxis around the time of certain dental/medical/surgical procedures. Routine upper and lower GI [[endoscopy]] (i.e. [[gastroscopy]] and [[colonoscopy]]), with or without [[biopsy]], are not usually considered indications for antibiotic prophylaxis.
Aortic regurgitation of any etiology is associated with a higher rate of infection of the valve, i.e. [[infective endocarditis]].<ref name="pmid7671919">{{cite journal| author=Michel PL, Acar J| title=Native cardiac disease predisposing to infective endocarditis. | journal=Eur Heart J | year= 1995 | volume= 16 Suppl B | issue=  | pages= 2-6 | pmid=7671919 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7671919  }} </ref>  The American Heart Association recommended that prophylaxis against [[infective endocarditis]] be limited only to patients with either [[prosthetic heart valves]], previous episode(s) of [[endocarditis]], or with certain types of [[congenital heart disease]].<ref name="urlwww.heart.org">{{cite web |url=http://www.americanheart.org/presenter.jhtml?identifier=4436 |title=www.heart.org |format= |work= |accessdate=2013-01-09}}</ref>  Patients with severe aortic regurgitation should avoid strenuous exercise and any exercise that greatly increases [[afterload]] such as weight lifting.


Not withstanding the foregoing, the [[American Heart Association]] has recently changed its recommendations regarding antibiotic prophylaxis for endocarditis. Specifically, as of 2007, it is recommended that such prophylaxis be limited only to:
==Antibiotic Prophylaxis==
*Those with prosthetic heart valves.
To reduce the risk of developing [[infective endocarditis]] among high-risk patients, antibiotic prophylaxis should be considered prior to certain dental/medical/surgical procedures. Such procedures may include dental extraction, deep scaling of the teeth, gum surgery, dental implants, treatment of [[esophageal varices]], dilation of [[esophageal stricture]]s, gastrointestinal surgery where the intestinal [[mucosa]] will be disrupted, [[prostate]] surgery, [[urethral stricture]] dilation, and [[cystoscopy]]. Note that routine upper and lower GI [[endoscopy]] (i.e. [[gastroscopy]] and [[colonoscopy]]), with or without [[biopsy]], are not usually considered indications for antibiotic prophylaxis.<ref>{{Cite web  | last =  | first =  | title = 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary | url = http://circ.ahajournals.org/content/early/2014/02/27/CIR.0000000000000029.full.pdf+html | publisher =  | date =  | accessdate = 4 March 2014 }}</ref>
*Those with previous episode(s) of [[endocarditis]].
 
*Those with certain types of [[congenital heart disease]] <ref>http://www.americanheart.org/presenter.jhtml?identifier=4436</ref>.
Not withstanding the foregoing, the American Heart Association has recently changed its recommendations regarding antibiotic prophylaxis for endocarditis. Specifically, as of 2007, it is recommended that such prophylaxis be limited only to:<ref name="urlwww.heart.org">{{cite web |url=http://www.americanheart.org/presenter.jhtml?identifier=4436 |title=www.heart.org |format= |work= |accessdate=2013-01-09}}</ref><ref>{{Cite web  | last =  | first =  | title = 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary | url = http://circ.ahajournals.org/content/early/2014/02/27/CIR.0000000000000029.full.pdf+html | publisher =  | date =  | accessdate = 4 March 2014 }}</ref><ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS |title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=[[Circulation]] |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=18820172 |accessdate=2011-03-24}}</ref>
 
*Those with [[prosthetic heart valves]]
*Those with previous episode(s) of [[endocarditis]]
*Those with certain types of [[congenital heart disease]]


==References==
==References==
{{reflist|2}}
{{reflist|}}


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Latest revision as of 16:51, 27 January 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. [2]; Lakshmi Gopalakrishnan, M.B.B.S. [3]; Mohammed A. Sbeih, M.D. [4]

Overview

Aortic regurgitation of any etiology is associated with a higher rate of infection of the valve, i.e. infective endocarditis.[1] The American Heart Association recommended that prophylaxis against infective endocarditis be limited only to patients with either prosthetic heart valves, previous episode(s) of endocarditis, or with certain types of congenital heart disease.[2] Patients with severe aortic regurgitation should avoid strenuous exercise and any exercise that greatly increases afterload such as weight lifting.

Antibiotic Prophylaxis

To reduce the risk of developing infective endocarditis among high-risk patients, antibiotic prophylaxis should be considered prior to certain dental/medical/surgical procedures. Such procedures may include dental extraction, deep scaling of the teeth, gum surgery, dental implants, treatment of esophageal varices, dilation of esophageal strictures, gastrointestinal surgery where the intestinal mucosa will be disrupted, prostate surgery, urethral stricture dilation, and cystoscopy. Note that routine upper and lower GI endoscopy (i.e. gastroscopy and colonoscopy), with or without biopsy, are not usually considered indications for antibiotic prophylaxis.[3]

Not withstanding the foregoing, the American Heart Association has recently changed its recommendations regarding antibiotic prophylaxis for endocarditis. Specifically, as of 2007, it is recommended that such prophylaxis be limited only to:[2][4][5]

References

  1. ↑ Michel PL, Acar J (1995). "Native cardiac disease predisposing to infective endocarditis". Eur Heart J. 16 Suppl B: 2–6. PMID 7671919.
  2. ↑ 2.0 2.1 "www.heart.org". Retrieved 2013-01-09.
  3. ↑ "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary". Retrieved 4 March 2014.
  4. ↑ "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary". Retrieved 4 March 2014.
  5. ↑ Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Retrieved 2011-03-24. Unknown parameter |month= ignored (help)

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