Navigating Heart Valve Issues After Endocarditis: Treatment Options Explained - Cardiology

Share to:

Endocarditis


Hello Dr.
Lin,
Last month, I developed infective endocarditis due to a green streptococcal infection, which my doctor said was triggered by a dental procedure.
This led to pulmonary edema, and I underwent four weeks of antibiotic treatment and have since been discharged.
Currently, I have mitral valve calcification and damage, heart murmurs, and signs of regurgitation.
My blood pressure is consistently between 96-100 mmHg (systolic) and around 50-60 mmHg (diastolic), with a pulse rate ranging from 98 to 105 bpm.

My doctor advised me to undergo dental treatment first before addressing my heart condition.
However, during my visit to the cardiology department, I was informed that my hemoglobin level is quite low, around 9 g/dL, which may be causing my elevated pulse rate.
They initiated iron supplementation and suggested that surgery is not immediately necessary.
Conversely, other cardiologists and surgeons have recommended that I undergo surgery to replace the metal valve, which would require lifelong anticoagulation therapy.
I am feeling quite overwhelmed and uncertain about what to do next.
Could you please provide me with some advice? Thank you very much!

lisa, 30~39 year old female. Ask Date: 2005/01/22

Dr. Lin Liangyu reply Cardiology


Hello: Endocarditis is primarily a condition treated by internal medicine, with surgery required only in a few specific situations.
During the acute phase, surgery may be necessary if there is heart failure, large bacterial vegetations, poor response to medication, septic emboli, or cardiac conduction abnormalities.
After antibiotic treatment, surgical intervention is generally indicated for severe heart failure symptoms due to valvular regurgitation or to prevent future heart failure in cases of cardiac enlargement.
From your letter, it seems you may fall into the latter category.
I recommend undergoing an echocardiogram; if there is no heart failure and no cardiac enlargement, regular outpatient follow-up is advised, and surgery may not be necessary at this time.
Alternatively, you could inform me of the reasons provided by other physicians for recommending surgery, so I can assess their rationale.
Wishing you a speedy recovery.

Reply Date: 2005/01/22

More Info


Navigating heart valve issues after experiencing endocarditis can be quite challenging, especially when faced with conflicting medical opinions regarding treatment options. Your situation, stemming from a bacterial infection that led to endocarditis, has resulted in complications such as mitral valve calcification, regurgitation, and low hemoglobin levels. Here’s a comprehensive overview of your condition and the potential treatment options available.


Understanding Your Condition
Endocarditis is an infection of the inner lining of the heart, often affecting the heart valves. In your case, the infection caused by Streptococcus viridans has led to damage to the mitral valve, resulting in regurgitation (backward flow of blood) and the presence of heart murmurs. The low blood pressure readings you mentioned (systolic pressure of 96-100 mmHg and diastolic pressure of 50-60 mmHg) indicate that your heart may be struggling to maintain adequate circulation, which can be exacerbated by anemia (low hemoglobin levels).


Treatment Options
1. Medical Management:
- Antibiotics: You have already undergone a four-week course of antibiotics, which is critical in treating the infection. Continuous monitoring for any signs of recurrent infection is essential.

- Iron Supplementation: Since your hemoglobin is low (around 9 g/dL), iron supplementation is necessary to address the anemia. This can help improve your overall energy levels and may stabilize your heart rate.

2. Surgical Intervention:
- Valve Replacement: Given the damage to your mitral valve, surgical options may be necessary. Valve replacement can be performed using mechanical or biological valves. Mechanical valves require lifelong anticoagulation therapy to prevent blood clots, while biological valves may not require long-term anticoagulation but have a shorter lifespan.

- Repair vs. Replacement: Depending on the extent of the damage, some valves can be repaired rather than replaced. This decision usually depends on the surgeon's assessment and the specific characteristics of your valve.

3. Monitoring and Follow-Up:
- Regular follow-ups with your cardiologist are crucial. They will monitor your heart function, valve performance, and hemoglobin levels. Echocardiograms will be essential to assess the severity of the regurgitation and any changes in heart structure.


Making a Decision
When faced with conflicting opinions from different specialists, consider the following steps:
- Seek a Second Opinion: If you are uncertain about the recommendations, seeking a second opinion from another cardiologist or a valve specialist can provide clarity.

- Discuss Risks and Benefits: Have an open discussion with your healthcare providers about the risks and benefits of surgery versus continued medical management. Understanding the potential outcomes can help you make an informed decision.

- Consider Your Lifestyle and Preferences: Think about how each option aligns with your lifestyle and preferences. For instance, if you are concerned about the lifelong commitment to anticoagulation therapy, this may influence your decision regarding valve replacement.


Conclusion
Navigating heart valve issues after endocarditis requires careful consideration of your treatment options. While medical management is essential, surgical intervention may become necessary depending on the severity of your valve dysfunction and overall heart health. Regular follow-ups and open communication with your healthcare team will be vital in managing your condition effectively. Remember, it’s important to prioritize your health and well-being, and making informed decisions with your medical team will help you achieve the best possible outcomes.

Similar Q&A

Understanding Heart Valve Degeneration: Treatment Options and Risks

The diagnosis is degenerative heart valve disease, leading to valve insufficiency and regurgitation. Currently, the primary treatment is medication. I would like to ask the doctor if there are other treatment options available and what the risks would be if such treatments are pu...


Dr. Chen Jili reply Cardiology
Currently, there is a catheter-based method for valve replacement, but patient conditions need to be evaluated, and health insurance does not cover the cost of the materials.

[Read More] Understanding Heart Valve Degeneration: Treatment Options and Risks


Understanding EECP Therapy: A Potential Solution for Heart Patients

Hello, Doctor He. My mother has undergone several cardiovascular surgeries, including mitral valve replacement (mechanical), tricuspid valve repair, pacemaker implantation, and treatment for varicose veins. Recently, she has been experiencing frequent lower limb edema and has bee...


Dr. He Dongjin reply Cardiology
Hello, it may be feasible, but it is advisable to discuss it with your attending physician. Changhua Hospital cares about you.

[Read More] Understanding EECP Therapy: A Potential Solution for Heart Patients


Understanding Rheumatic Heart Disease: Post-Surgery Care and Concerns

Hello Doctor: I was diagnosed with rheumatic heart disease 16 years ago, but since the condition was not very severe, I managed my blood pressure with antihypertensive medications. However, this year my condition worsened, leading to an emergency hospitalization where I underwent...


Dr. Zhong Yuxun reply Cardiology
Hello Andy, If the artificial valve is a porcine valve, it typically needs to be replaced after about 10 years. If it is a mechanical valve, it can be used for a lifetime, but lifelong anticoagulation with Coumadin is required. All artificial valves need to be well-maintained an...

[Read More] Understanding Rheumatic Heart Disease: Post-Surgery Care and Concerns


Managing Tricuspid Regurgitation After Pacemaker Implantation

Hello Dr. Wu, my mother had a mechanical mitral valve replacement a few years ago and has recently had a pacemaker implanted. She has been taking diuretics, but since the pacemaker was placed, her lower extremity edema has been harder to control, and her urine output is often low...


Dr. Wu Xueming reply Cardiology
Diuretics can address the issue of excess fluid, but if there is significant deterioration in cardiac function, additional heart failure medications are still necessary.

[Read More] Managing Tricuspid Regurgitation After Pacemaker Implantation


Related FAQ

Endocarditis

(Cardiology)

Heart Valve

(Cardiology)

Valve Insufficiency

(Cardiology)

Post-Cardiac Catheterization

(Cardiology)

Mitral Valve Prolapse

(Cardiology)

Tricuspid Valve Regurgitation

(Cardiology)

Vsd

(Cardiology)

Pvcs

(Cardiology)

Atrial Septal Defect

(Cardiology)

After Covid-19 Vaccination

(Cardiology)