How can infective endocarditis be managed?

Question

Hello doctor,

I recently visited my general practitioner due to experiencing shortness of breath and an odd sensation in my heart area. Although I suspected it was nothing serious, I went in anyway just to be sure. The sensation in my heart area is not painful; it feels more like a sense of "fullness" or "tightness." I underwent an EKG, and the results indicated a "minor anterior repolarization disturbance, consider ischemia, left ventricular overload, or nonspecific change, with flat or low negative T waves in AVF and negative T waves in III."

I am a 29-year-old male in generally good shape. I smoked for about ten years but quit two years ago, and I still smoke marijuana daily. Additionally, about eight years ago, I had a root canal that has since re-infected twice. I am scheduled for an apicoectomy next month to address the asymptomatic infection. I mention this because I am worried that the untreated infection could have spread from the root of my tooth to my heart. I also live at an elevation of 7,000 feet, which may contribute to my shortness of breath, although I have lived here for about six years. I am currently feeling very anxious about potentially having a serious issue. Can anyone help me understand what these results mean? My general practitioner referred me to a cardiologist, but I do not want to be a nervous wreck until I hear from them.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I have carefully reviewed your detailed query. You definitely need an in-person consultation with a cardiologist for a proper evaluation of your issues. An EKG (electrocardiogram) alone is not conclusive in such cases. We need to listen to your heart and conduct a thorough physical exam. Tests may include but are not limited to, an exercise stress test, echocardiography, thallium scan, chest X-ray, CT (computed tomography) scan, angiography, and others if necessary. Once these are ruled out, we can confidently determine whether there is any issue that requires proper management.

Yes, infections can spread from the teeth or throat to the heart and can be diagnosed. Blood work is also helpful in this regard, as it can identify infectious agents in the blood and any changes due to infection. If there is a blockage in any of the blood vessels supplying the heart, there may be a risk of shortness of breath, and a patient can experience this even while talking, with minimal physical activity, or when climbing stairs.

Do not panic; just follow the directions from your primary care physician and go for a cardiologist evaluation. In the meantime, proceed with the apicoectomy and stay in touch with your dentist.

I hope this helps.

Answer 2

Hello,

Welcome back to icliniq.com.

We are not sure what is actually going on in your heart. Once the diagnosis is confirmed, we can proceed from there to treat the cause. It is not sepsis; rather, it is bacteremia, which simply means bacteria in the blood. These bacteria can cause an infection of the heart if they lodge in the lining of the heart valves. Bacteremia can even result from routine activities like vigorous tooth brushing. Gums that bleed profusely and more frequently pose a greater risk of bacteremia.

Sepsis is a different condition characterized by a widespread reaction of the whole body to bacteria in the blood (bacteremia), leading to a cascade of mechanisms that may result in the failure of multiple organs, including the heart.

Please do not confuse the two terms; just follow the previously mentioned instructions. An infection of the heart in this way can be referred to as infective endocarditis, and it is manageable. I recommend seeking medical attention as soon as possible, as earlier intervention is always better. Your cardiologist will discuss treatment options in detail, and you can choose accordingly. Antibiotics are still the mainstay of treatment for infective endocarditis.

I hope this helps.

Regards.

Answer 3

Hello,

Welcome back to icliniq.com.

If shortness of breath is accompanied by fainting, chest pain, and nausea, it is better to go for an emergency visit, as these symptoms could indicate serious heart issues. Otherwise, you may wait for your appointment with the cardiologist.

I hope everything remains under control and that you do not need to go to the emergency department.

Regards.