Aortic stenosis precautions and prophylaxis: Difference between revisions

Jump to navigation Jump to search
No edit summary
 
(14 intermediate revisions by 6 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{| class="infobox" style="float:right;"
|-
| [[File:Siren.gif|30px|link=Aortic stenosis resident survival guide]]|| <br> || <br>
| [[Aortic stenosis resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
|}
{{Aortic stenosis}}
{{Aortic stenosis}}


{{CMG}}
{{CMG}} {{AE}} {{USAMA}}


==Overview==
==Overview==
People with aortic stenosis of any etiology are at risk for the development of infection of their stenosed valve, i.e. [[infective endocarditis]] and antibiotic prophylaxis should be considered.
Aortic stenosis of any etiology is associated with a higher rate of infection of the stenosed valve, i.e. [[infective endocarditis]]. The American Heart Association recommended that prophylaxis against [[infective endocarditis]] be limited only to patients with either [[prosthetic heart valves]], previous episode(s) of [[endocarditis]], or with certain types of [[congenital heart disease]]. Patients with severe aortic stenosis should avoid strenuous exercise and any exercise that greatly increases [[afterload]] such as weight lifting.


==Antibiotic Prophylaxis==
==Antibiotic Prophylaxis==
To reduce the risk of developing [[infective endocarditis]] antibiotic prophylaxis should be considered prior to certain dental/medical/surgical procedures. Such procedures may include dental extraction, deep scaling of the teeth, gum surgery, dental implants, treatment of [[esophageal varices]], dilation of [[esophageal stricture]]s, gastrointestinal ''surgery'' where the intestinal [[mucosa]] will be disrupted, [[prostate]] surgery, [[urethral stricture]] dilation, and [[cystoscopy]]. Note that routine upper and lower GI [[endoscopy]] (i.e. [[gastroscopy]] and [[colonoscopy]]), with or without [[biopsy]], are not usually considered indications for antibiotic prophylaxis.
Aortic stenosis of any etiology is associated with a higher rate of infection of the stenosed valve, i.e. [[infective endocarditis]].<ref name="pmid7671919">{{cite journal| author=Michel PL, Acar J| title=Native cardiac disease predisposing to infective endocarditis. | journal=Eur Heart J | year= 1995 | volume= 16 Suppl B | issue=  | pages= 2-6 | pmid=7671919 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7671919  }} </ref> To reduce the risk of developing [[infective endocarditis]] among high-risk patients, antibiotic prophylaxis should be considered prior to certain dental/medical/surgical procedures. Such procedures may include dental extraction, deep scaling of the teeth, gum surgery, dental implants, treatment of [[esophageal varices]], dilation of [[esophageal stricture]]s, gastrointestinal surgery where the intestinal [[mucosa]] will be disrupted, [[prostate]] surgery, [[urethral stricture]] dilation, and [[cystoscopy]]. Note that routine upper and lower GI [[endoscopy]] (i.e. [[gastroscopy]] and [[colonoscopy]]), with or without [[biopsy]], are not usually considered indications for antibiotic prophylaxis.


Not withstanding the foregoing, the American Heart Association has recently changed its recommendations regarding antibiotic prophylaxis for endocarditis. Specifically, as of 2007, it is recommended that such prophylaxis be limited only to:
Not withstanding the foregoing, the American Heart Association has changed its recommendations regarding antibiotic prophylaxis for endocarditis. Specifically, as of 2007, it is recommended that such prophylaxis be limited only to:<ref name="pmid28233191">{{cite journal| author=Thornhill MH, Dayer M, Lockhart PB, Prendergast B| title=Antibiotic Prophylaxis of Infective Endocarditis. | journal=Curr Infect Dis Rep | year= 2017 | volume= 19 | issue= 2 | pages= 9 | pmid=28233191 | doi=10.1007/s11908-017-0564-y | pmc=5323496 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28233191  }} </ref><ref name="WilsonTaubert2007">{{cite journal|last1=Wilson|first1=Walter|last2=Taubert|first2=Kathryn A.|last3=Gewitz|first3=Michael|last4=Lockhart|first4=Peter B.|last5=Baddour|first5=Larry M.|last6=Levison|first6=Matthew|last7=Bolger|first7=Ann|last8=Cabell|first8=Christopher H.|last9=Takahashi|first9=Masato|last10=Baltimore|first10=Robert S.|last11=Newburger|first11=Jane W.|last12=Strom|first12=Brian L.|last13=Tani|first13=Lloyd Y.|last14=Gerber|first14=Michael|last15=Bonow|first15=Robert O.|last16=Pallasch|first16=Thomas|last17=Shulman|first17=Stanford T.|last18=Rowley|first18=Anne H.|last19=Burns|first19=Jane C.|last20=Ferrieri|first20=Patricia|last21=Gardner|first21=Timothy|last22=Goff|first22=David|last23=Durack|first23=David T.|title=Prevention of Infective Endocarditis|journal=Circulation|volume=116|issue=15|year=2007|pages=1736–1754|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.106.183095}}</ref>
*Those with [[prosthetic heart valves]]
*Prosthetic cardiac valve or prosthetic material used for cardiac valve repair.
*Those with previous episode(s) of [[endocarditis]].
*Previous episode(s) of [[endocarditis]]
*Those with certain types of [[congenital heart disease]] <ref>http://www.americanheart.org/presenter.jhtml?identifier=4436</ref>.
*Congenital heart disease (CHD)
:*Unrepaired cyanotic CHD, including palliative shunts and conduits
:*Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first 6 months after the procedure.
:*Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization).
*Cardiac transplantation recipients who develop cardiac valvulopathy.


==Vigorous Exertion==
==Vigorous Exertion==
Given the risk of myocardial ischemia and [[sudden cardiac death]], patients with severe aortic stenosis (< 1.0 cm<sup>2</sup>) should avoid strenuous physical activity including weightlifting and other activities that increase [[afterload]]
Given the risk of myocardial ischemia and [[sudden cardiac death]], patients with severe aortic stenosis (< 1.0 cm<sup>2</sup>) should avoid strenuous physical activity including weightlifting and other activities that increase [[afterload]].


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}
[[CME Category::Cardiology]]


[[Category:Disease]]
[[Category:Disease]]
Line 27: Line 40:
[[Category:Cardiac surgery]]
[[Category:Cardiac surgery]]
[[Category:Surgery]]
[[Category:Surgery]]
{{WH}}
{{WS}}

Latest revision as of 17:01, 6 March 2020



Resident
Survival
Guide

Aortic Stenosis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Aortic Stenosis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Cardiac Stress Test

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography

Cardiac Catheterization

Aortic Valve Area

Aortic Valve Area Calculation

Treatment

General Approach

Medical Therapy

Surgery

Percutaneous Aortic Balloon Valvotomy (PABV) or Aortic Valvuloplasty

Transcatheter Aortic Valve Replacement (TAVR)

TAVR vs SAVR
Critical Pathway
Patient Selection
Imaging
Evaluation
Valve Types
TAVR Procedure
Post TAVR management
AHA/ACC Guideline Recommendations

Follow Up

Prevention

Precautions and Prophylaxis

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Aortic stenosis precautions and prophylaxis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Aortic stenosis precautions and prophylaxis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Aortic stenosis precautions and prophylaxis

CDC on Aortic stenosis precautions and prophylaxis

Aortic stenosis precautions and prophylaxis in the news

Blogs on Aortic stenosis precautions and prophylaxis

Directions to Hospitals Treating Aortic stenosis precautions and prophylaxis

Risk calculators and risk factors for Aortic stenosis precautions and prophylaxis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]

Overview

Aortic stenosis of any etiology is associated with a higher rate of infection of the stenosed valve, i.e. infective endocarditis. The American Heart Association recommended that prophylaxis against infective endocarditis be limited only to patients with either prosthetic heart valves, previous episode(s) of endocarditis, or with certain types of congenital heart disease. Patients with severe aortic stenosis should avoid strenuous exercise and any exercise that greatly increases afterload such as weight lifting.

Antibiotic Prophylaxis

Aortic stenosis of any etiology is associated with a higher rate of infection of the stenosed valve, i.e. infective endocarditis.[1] To reduce the risk of developing infective endocarditis among high-risk patients, antibiotic prophylaxis should be considered prior to certain dental/medical/surgical procedures. Such procedures may include dental extraction, deep scaling of the teeth, gum surgery, dental implants, treatment of esophageal varices, dilation of esophageal strictures, gastrointestinal surgery where the intestinal mucosa will be disrupted, prostate surgery, urethral stricture dilation, and cystoscopy. Note that routine upper and lower GI endoscopy (i.e. gastroscopy and colonoscopy), with or without biopsy, are not usually considered indications for antibiotic prophylaxis.

Not withstanding the foregoing, the American Heart Association has changed its recommendations regarding antibiotic prophylaxis for endocarditis. Specifically, as of 2007, it is recommended that such prophylaxis be limited only to:[2][3]

  • Prosthetic cardiac valve or prosthetic material used for cardiac valve repair.
  • Previous episode(s) of endocarditis
  • Congenital heart disease (CHD)
  • Unrepaired cyanotic CHD, including palliative shunts and conduits
  • Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first 6 months after the procedure.
  • Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization).
  • Cardiac transplantation recipients who develop cardiac valvulopathy.

Vigorous Exertion

Given the risk of myocardial ischemia and sudden cardiac death, patients with severe aortic stenosis (< 1.0 cm2) should avoid strenuous physical activity including weightlifting and other activities that increase afterload.

References

  1. Michel PL, Acar J (1995). "Native cardiac disease predisposing to infective endocarditis". Eur Heart J. 16 Suppl B: 2–6. PMID 7671919.
  2. Thornhill MH, Dayer M, Lockhart PB, Prendergast B (2017). "Antibiotic Prophylaxis of Infective Endocarditis". Curr Infect Dis Rep. 19 (2): 9. doi:10.1007/s11908-017-0564-y. PMC 5323496. PMID 28233191.
  3. Wilson, Walter; Taubert, Kathryn A.; Gewitz, Michael; Lockhart, Peter B.; Baddour, Larry M.; Levison, Matthew; Bolger, Ann; Cabell, Christopher H.; Takahashi, Masato; Baltimore, Robert S.; Newburger, Jane W.; Strom, Brian L.; Tani, Lloyd Y.; Gerber, Michael; Bonow, Robert O.; Pallasch, Thomas; Shulman, Stanford T.; Rowley, Anne H.; Burns, Jane C.; Ferrieri, Patricia; Gardner, Timothy; Goff, David; Durack, David T. (2007). "Prevention of Infective Endocarditis". Circulation. 116 (15): 1736–1754. doi:10.1161/CIRCULATIONAHA.106.183095. ISSN 0009-7322.

Template:WH Template:WS CME Category::Cardiology