Dentistry

What is infective endocarditis?

Infective endocarditis is an infection of the inner lining of the heart chambers (endocardium) or heart valves. It is usually caused by microscopic organisms, especially bacteria, that enter the heart through the bloodstream and settle there.
Who is at risk?

The following people are more likely to develop endocarditis:

• Patients with valvular heart disease
• People with a history of heart surgery
• Patients with congenital heart defects
• People who have had rheumatic fever in childhood and have valvular damage.
• Patients with an artificial heart valve or any type of foreign material implanted in the body

• Symptoms of infective endocarditis

  Symptoms of endocarditis can vary, but are often accompanied by fever.
  Other common symptoms include:
  

  • Fatigue and lethargy
  • Muscle aches
  • Night sweats
  • Loss of appetite
  • Flu-like symptoms

  💡 If you experience these symptoms, especially in people with heart disease, it is important to see a doctor immediately.
  
  

Antibiotics to Prevent Endocarditis

In some cases, your doctor may recommend taking antibiotics before certain medical procedures or dental surgeries (including scaling) to prevent infective endocarditis.

According to medical guidelines, taking preventive antibiotics is only recommended for people with severe underlying heart disease and is not necessary for all patients.

• Therapies that can put bacteria into the bloodstream

  Some treatments may put bacteria into the bloodstream, including:

  • Dental procedures that may cause bleeding (such as scaling)
  • Tonsillectomy and tonsillectomy
  • Bronchoscopy (direct viewing of the airways)
  • Some respiratory, digestive, or urinary tract surgeries
  • Gallbladder or prostate surgery
• Ways to help prevent infective endocarditis

  To reduce the risk of endocarditis, it is recommended to observe the following points:
  
  

  • Maintain good oral hygiene and inform your dentist about heart disease
  • Follow your doctor's instructions carefully about taking antibiotics before dental procedures
  • Carry a medical card or document containing information about infective endocarditis

  💡 If you have heart disease, be sure to inform your doctor before undergoing any treatment or surgery.

Warfarin Tablets

Patients with metal heart valves need to take warfarin regularly to prevent blood clots. Not taking it or taking it irregularly can lead to serious and dangerous complications.
Patients with porcine or human heart valves usually do not need to take warfarin, except in cases of irregular heart rhythm. However, with porcine valves, warfarin is necessary for the first few months after surgery.

• Monitoring the effect of warfarin with PT and INR tests

  The effect of warfarin is assessed through blood tests including prothrombin time (PT) and international normalized ratio (INR).

• PT

  The normal value is 12 to 13 seconds, but in warfarin users (depending on the type and location of the valve) it is usually set between 18 and 25 seconds.

• INR

  The normal value is 1 and in patients taking warfarin, it is adjusted between 2 and 3.5, depending on the type, location, and number of valves.

• Important points

  Long-term use of warfarin is safe if accompanied by regular monitoring of PT and INR.
  In the absence of proper monitoring:

  • Excessive increase in INR can increase the risk of bleeding.
  • Decrease in INR below the desired level may cause clotting of the prosthetic valve.

  💡 Strictly following the doctor's instructions and performing regular blood tests plays a key role in preventing these complications.

Drug interactions and important points about warfarin

Drugs that increase PT-INR:

Aspirin, ibuprofen, indomethacin, mefenamic acid, antidiabetic drugs, cimetidine, allopurinol, clofibrate, gemfibrozil, heparin, isoniazid, methimazole, metronidazole, alcohol consumption, chloramphenicol, erythromycin, danazol, diazoxide, dextrothyroxine, glucagon, flu vaccine, ketoconazole, meperidine, methotrexate, methyldopa, nalidixic acid, nifedipine, phenylbutazone, quinidine, streptokinase, thyroid hormones, verapamil, vitamin A and vitamin E

Drugs that decrease PT-INR:

Birth control pills, carbamazepine, gastric juice, cigarettes, vitamin K, diuretics, chlorobutanol, colesevelam, rifampin, estrogens, laxatives

• Notes to note when taking warfarin tablets
  • The dosage of the medicine should be based only on the doctor's advice; do not change it arbitrarily.
  • Always take the medicine at the same time of day; preferably in the evening.
  • Keep the medicine away from light, moisture, and heat, and out of the reach of children.
  • Take on an empty stomach for better absorption.
  • If daily dose is missed: Take on the same day; if you notice the next day, do not double the dose and monitor PT/INR and inform your doctor.
  • Always consult your doctor before taking any other medication or vitamins. (Warfarin should not be taken with vitamin K)
  • Be careful when working with sharp or dangerous tools; bleeding may stop more slowly than normal.
  • Carry a medical ID card (with the type of illness, surgery, and valve type listed).
  • Do not take aspirin or ibuprofen as a pain reliever while taking warfarin.
  • Inform your doctor if you have a fever, new illness, change in diet, or any unusual condition.
• Warning signs of high PT/INR

  If any of the following occurs, see a doctor immediately:

  • Bleeding gums
  • Black stools (note: taking iron tablets also turns stools black)
  • Unexplained bruising
  • Abnormally heavy bleeding
  • Persistent severe headache
  • Vomiting blood

  💡 It is recommended to have a urine and stool test every 6 months.