Infection Risks: Antibiotics and Heart Conditions Explained

Infection concerns?

I originally had an inflamed sebaceous cyst scheduled for removal in two weeks.
The doctor prescribed a one-day course of prophylactic antibiotics, but due to unforeseen circumstances, I didn't go.
Yesterday, I consulted another physician who insisted that I immediately clear the affected area, and I was subsequently sent for outpatient surgery.
I would like to ask the doctor about my condition: I have mitral valve prolapse and mild aortic regurgitation.
Previously, cardiologists advised that I should take antibiotics before dental procedures, but they didn't specify how to take them.
In my case, I took them only 30 minutes before the procedure.
Was the antibiotic prescribed last time effective? Is there a possibility that a cyst approximately 2.5 cm deep and 1 cm wide (on my shoulder) could cause an infection leading to endocarditis? If so, what symptoms would I experience? Would there be continuous fever? I'm concerned because tonight, I suddenly started experiencing pain in my left jaw and I'm worried it might be an infection.

6, 30~39 year old female. Ask Date: 2019/11/15

Dr. Hong Yuanbin reply Internal Medicine

Hello, regarding aortic stenosis with a bicuspid aortic valve and mitral valve prolapse, prophylactic antibiotics are only necessary in certain situations that involve bleeding, such as tooth extractions, due to the concern of infective endocarditis.
For a simple cyst removal surgery, prophylactic antibiotics are generally not required.
However, if you are still very concerned, you can take the antibiotics prescribed by your doctor 30 minutes before the procedure, and that should still be effective.
As for the pain in your lower jaw, it is likely unrelated to the cyst removal surgery and may be due to a bruise or dental issues.
Thank you for your question.

Reply Date: 2019/11/15

More Info

Infection risks associated with heart conditions, particularly in patients with structural heart abnormalities like mitral valve prolapse and aortic regurgitation, are a significant concern. Your situation involves a pre-existing condition that may increase the risk of infective endocarditis, especially after surgical procedures or invasive dental work.
Infective endocarditis is an infection of the inner lining of the heart chambers and valves, often caused by bacteria entering the bloodstream. Patients with certain heart conditions, such as yours, are at a higher risk because the structural abnormalities can create turbulent blood flow, which may damage the heart lining and make it more susceptible to infection.

Regarding your specific questions about the use of prophylactic antibiotics before procedures: it is standard practice to administer antibiotics prior to certain dental or surgical procedures to prevent bacterial endocarditis in at-risk patients. The timing and choice of antibiotic can vary based on the procedure and the patient's medical history. Typically, antibiotics are recommended to be taken about 30 to 60 minutes before the procedure to ensure adequate levels in the bloodstream when the procedure is performed.

In your case, the antibiotic prescribed for your inflamed cyst (lipoma) would generally be effective if taken as directed. However, if you did not take it until shortly before the procedure, it may not have provided the optimal level of protection against potential bacteria entering your bloodstream during the surgery.
As for the risk of developing infective endocarditis from a cyst removal, while it is generally low, it is not impossible. If bacteria were to enter your bloodstream during the procedure, they could potentially colonize on the heart valves or damaged heart tissue, leading to endocarditis. Symptoms of infective endocarditis can include:
1. Fever: Often persistent and may be accompanied by chills.

2. Fatigue: General malaise and weakness.

3. Unexplained weight loss: Over time, patients may notice a significant drop in weight.

4. Night sweats: Excessive sweating during the night.

5. New heart murmurs: Changes in heart sounds may be detected during a physical examination.

6. Petechiae: Small, pinpoint red or purple spots on the skin, which can occur due to small blood vessel bleeding.

7. Pain in joints or muscles: This can occur as the body responds to the infection.

If you are experiencing sudden pain in your left jaw, it could be a sign of an infection, especially if it is accompanied by other symptoms like fever or fatigue. Jaw pain can sometimes be related to dental issues or infections, which could also lead to concerns about endocarditis if bacteria were to enter the bloodstream.

Given your concerns and symptoms, it is crucial to seek medical attention promptly. A healthcare provider can perform the necessary evaluations, which may include blood cultures to check for the presence of bacteria in your bloodstream, echocardiograms to assess your heart's condition, and other relevant tests.
In summary, while the risk of developing infective endocarditis from a cyst removal is relatively low, it is essential to remain vigilant about any new or unusual symptoms, especially given your underlying heart conditions. Prophylactic antibiotics are an important preventive measure, and if you have any doubts about your treatment or symptoms, do not hesitate to consult your healthcare provider for further guidance.

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