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{{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 and Prophylaxis==
==Overview==
People with aortic insufficiency of any etiology 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 stenosis of any etiology is associated with a higher rate of infection of the stenosed 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 stenosis 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 valve]]s.
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.
*Those with previous episode(s) of [[endocarditis]].
 
*Those with certain types of [[congenital heart disease]].
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:
*Those with [[prosthetic heart valves]]
*Those with previous episode(s) of [[endocarditis]]
*Those 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>


==References==
==References==

Revision as of 16:41, 6 January 2015

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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 stenosis of any etiology is associated with a higher rate of infection of the stenosed 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 stenosis 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.

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:

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.

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