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التهاب الشغاف وإصابة الصمامات


التهاب الشغاف وإصابة الصمامات

المعلومة

إن حدوث التهاب الشغاف الجرثومي تحت الحاد على صمام أصلي أشيع في الجانب الأيسر من القلب وانسدال التاجي هو أشيع آفة صمامية تترافق مع التهاب الشغاف تحت الحاد .
عند مدمني المخدرات عادة ما يصاب الجانب الأيمن من القلب وخاصة دسام مثلث الشرف ..

المرجع

MedStudy

Dr.Hiba's picture
by
طالب دراسات عليا

Quote:
وانسدال التاجي هو أشيع آفة صمامية تترافق مع التهاب الشغاف تحت الحاد .

وهو أشيع افة دسامية تشاهد بالحياة العملية ..
شكرا Razz

qusei

40 y.o man with Bicuspid aortic valve, he wants to do dental work up, he is allergic to PCN, wat is the best appropriate NS=>
1- Nothing.
2- Nafcillin.
3- Clinda
4- Vanco

الجواب القديم: كلندا الجواب الحديث:
هي التوصيات الجديدة، اقرؤوهم منيح:

AHA GUIDELINE — The 2007 AHA guideline for the prevention of infective endocarditis (IE) [1] made major revisions to the 1997 AHA guideline, the 2005 update of those guidelines published by the Medical Letter [18] , and the 2006 ACC/AHA guideline on the management of valvular heart disease [19] .

The recommendation for antimicrobial prophylaxis for dental and other procedures (and others) is now limited to those patients with cardiac conditions with the highest risk of adverse outcome from IE [1] . In contrast, the prior guidelines recommended prophylaxis for patients at moderate to high risk of IE, a much larger population [18,19] . (See "Patients at the highest risk" below).

The rationale for this change was to make guidelines more evidence-based since, as noted above, there is no convincing evidence that antimicrobial prophylaxis provides significant benefit in most patients in terms of prevention of IE. This change has the added advantage of simplifying care for practitioners and patients. (See "Prevention of endocarditis" above).

The following points were made by the AHA in support of their recommendation for the important change [1] :

IE is much more likely to result from frequent exposure to random bacteremias associated with daily activities (eg, tooth brushing) than from bacteremia caused by a dental, gastrointestinal, or genitourinary procedure.
Prophylaxis may prevent an exceedingly small number of cases of IE, if any, in individuals who undergo these procedures.
The risk of antibiotic-associated adverse events exceeds the benefit, if any, from prophylactic antibiotic therapy.
Maintenance of optimal oral health and hygiene may reduce the incidence of bacteremia from daily activities and is therefore more important than prophylactic antibiotics for a dental procedure to reduce the risk of IE.
The guideline recommendations were based upon results of in vitro studies, clinical experience, data from experimental animal models, and assessment of both the bacteria most likely to produce bacteremia from a given site and those most likely to result in endocarditis.

The guidelines are not intended to be the standard of care in all instances in which prophylactic antibiotic therapy might be considered [1] . Practitioners may wish to exercise their own judgment in selecting the dose and duration of antibiotic therapy in individual cases or in special circumstances.

Patients at the highest risk — Prophylaxis was recommended only in those settings associated with the highest risk of developing an adverse outcome if IE were to occur [1] . Patients with the following cardiac conditions were considered to meet this criterion:

Prosthetic heart valves, including bioprosthetic and homograft valves. (See "Routine management of patients with prosthetic heart valves", section on Endocarditis prophylaxis).
A prior history of IE.
Unrepaired cyanotic congenital heart disease, including palliative shunts and conduits.
Completely repaired congenital heart defects with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure.
Repaired congenital heart disease with residual defects at the site or adjacent to the site of the prosthetic device.
Cardiac "valvulopathy" in a transplanted heart. Valvulopathy is defined as documentation of substantial leaflet pathology and regurgitation [20] .
Similar limited criteria for prophylaxis were proposed in 2006 by the Working Party of the British Society for Antimicrobial Chemotherapy [20] . "Valvulopathy" in a transplanted heart was not included, but these guidelines also included complex left ventricular outflow abnormalities including aortic stenosis and bicuspid aortic valves, or acquired valvulopathy or mitral valve prolapse with echocardiographic evidence of substantial leaflet pathology and regurgitation [20] .

No longer indicated — Common valvular lesions for which antimicrobial prophylaxis is no longer recommended in the 2007 AHA guidelines include bicuspid aortic valve, acquired aortic or mitral valve disease (including mitral valve prolapse with regurgitation and those who have undergone prior valve repair), and hypertrophic cardiomyopathy with latent or resting obstruction.

Procedures that may result in transient bacteremia — The 2007 AHA guidelines recommend that antimicrobial prophylaxis be given to patients with the cardiac lesions cited above when they undergo procedures likely to result in bacteremia with a microorganism that has the potential ability to cause endocarditis [1] .

Dental — The risk of IE is generally considered to be the highest for all dental procedures that involve manipulation of either gingival tissue or the periapical region of teeth or perforation of the oral mucosa [1,20] .

All individuals at risk for developing IE should establish and maintain a program of oral health care including regular professional care, the regular use of manual or powered toothbrushes, dental floss, and other plaque removing devices.

Respiratory tract — Although bacteremia with a variety of organisms accompanies respiratory tract procedures, there is no direct evidence for them causing IE. The AHA guideline does not recommend routine antimicrobial prophylaxis for procedures unless they involve incision or biopsy of the respiratory tract mucosa [1] . Examples of such procedures include tonsillectomy, adenoidectomy, or bronchoscopy with biopsy.

In patients who undergo an invasive respiratory tract procedure as part of the treatment of an established infection:

The ongoing antibiotic regimen should include an agent that is active against viridans group streptococci.
In patients who have a respiratory tract infection that is known or suspected to be caused by Staphylococcus aureus, the regimen should include an agent active against S. aureus.
Genitorurinary tract — The risk of bacteremia is significantly lower for invasive genitourinary (GU) procedures such as dilation of strictures, insertions of catheters, and prostatectomy compared with dental or respiratory tract infections. Invasive gastrointestinal (GI) procedures, such as lower bowel endoscopy with biopsy or endoscopic retrograde cholangiopancreatography, have an even lower risk of IE since bacteremia due to organisms capable of causing endocarditis occurs in less than 5 to 10 percent of cases.

The AHA guideline no longer considers any GI (including diagnostic colonoscopy or esophagogastroduodenoscopy ) or GU procedures high risk and therefore do not recommend routine use of IE prophylaxis even in patients with the highest risk cardiac conditions defined above [1] . (See "Antibiotic prophylaxis for gastrointestinal endoscopic procedures").

Some patients with established infections of the GI or GU tract may have enterococcal bacteremia. For patients with the highest risk cardiac conditions who have ongoing GI or GU tract infection or who are undergoing a procedure for which antibiotic therapy to prevent wound infection or sepsis is indicated, the AHA suggests an antibiotic regimen that includes an agent active against enterococci. (See "Choice of antimicrobial agent" below).

For those patients with an enterococcal urinary tract infection or colonization scheduled to undergo elective cystoscopy or urinary tract manipulation, eradication of the organism prior to the procedure should be attempted.

Skin or musculoskeletal tissue — Patients with infected skin, skin structure, or musculoskeletal tissue may have polymicrobial infections. When such patients undergo a surgical procedure, only bacteremia with staphylococci or beta-hemolytic streptococci are likely to cause IE. The appropriate antibiotic regimen is discussed below

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DAM's picture
DAM

Quote:
The recommendation for antimicrobial prophylaxis for dental and other procedures (and others) is now limited to those patients with cardiac conditions with the highest risk of adverse outcome from IE [1] . In contrast, the prior guidelines recommended prophylaxis for patients at moderate to high risk of IE, a much larger population [18,19] . (See "Patients at the highest risk" below).

تماما ,هيك مكتوب بالكابلان الجديد

يعني يلا لسا ما حفظ الحالات متوسطة الخطورة لا يحفظهم ويعذب حالهEye-wink

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