What is the diagnostic procedure for endocarditis?
The diagnosis differs according to whether infectious bacterial endocarditis or non-pathogenic endocarditis is suspected. Infective endocarditis is diagnosed on the basis of several criteria. The two most important criteria are so-called “positive blood cultures” and abnormalities in the ultrasound or CT examination.
In order to obtain the former, blood is taken from the patient in several places. This blood is injected into special bottles in which bacteria can be cultivated. The so-called “blood cultures” are used to detect bacteria circulating in the blood and provide an important indication of possible endocarditis.
If the ultrasound examination also reveals abnormalities of the inner walls of the heart or valves, the suspicion of endocarditis is confirmed. If these main criteria are not sufficiently fulfilled, further examinations can be performed in order to make a diagnosis of endocarditis. Other important criteria that can confirm a suspected diagnosis are drug abuse, other heart diseases, high fever or certain vascular diseases.
- Main artery (aorta)
- Left atrium
- Left atrial valve = mitral valve (closed)
- Left heart valve = aortic valve (open)
- Left ventricle
- Right ventricle
- Inferior vena cava (inferior vena cava)
- Right heart valve= pulmonary valve (open)
- Right atrium (atrium)
- Superior vena cava (vena cava superior)
Endocarditis Prophylaxis
The recommendations for endocarditis prophylaxis have been increasingly restricted in recent years in order to avoid unnecessary antibiotic administration and thus to prevent the increasing resistance of the bacteria.Endocarditis prophylaxis is recommended nowadays for patients with heart valve replacement, patients with survived endocarditis, patients with certain congenital heart defects or operated heart defects with the use of prosthetic material. Since there is no overall agreement on the extent to which endocarditis prophylaxis should be taken beyond this, it is ultimately a matter of an individual case decision. Prophylaxis includes the administration of antibiotics and should be carried out in particular after interventions in the mouth and throat area, for example during dental treatments such as the removal of tartar and root canal treatments, the removal of the tonsils (tonsillectomy) and other interventions in this area.
For high-risk groups, endocarditis prophylaxis is also recommended for many other surgical procedures, for example, for interventions in the gastrointestinal or respiratory tract and in the urogenital tract. The antibiotic is administered approximately 30-60 minutes before the procedure. Amoxicillin or ampicillin are preferred for dental procedures, ampicillin or piperacillin for urogenital or gastrointestinal procedures. The antibiotics selected depend on the expected germ flora of the operated area. In the case of special germs, the antibiotic prophylaxis must be adjusted accordingly.
