Sarah’s Endocarditis, Swine Flu (H1N1 Virus) And Heart Valve Scare

I just received a roller coaster email from Sarah about endocarditis, swine flu (H1N1 virus) and heart valves that made my head spin. In the end, Sarah raises some great points for patients and caregivers about endocarditis, swine flu, fevers, false tests and dental work. Here is what she writes:

Adam,

I just returned from a very scary 36 hours that landed me in the hospital with fears of endocarditis.

Last Friday, I called my primary care doctor because I had been fighting a cough, congestion and fever for over a week. She did a quick test for the flu, it came up negative. I told her that I had dental work to put on a crown about 10 days earler, two days before the fever started. Well, that set up a red flag for the possibility of a heart valve infection (endocarditis) even though I had used amoxicillin as advised by my doctor before the dental work.

At this point everything went into warp speed as they put me through a battery of diagnostic tests: EKG, echocardiogram, chest x-ray, blood cultures AND a transesophageal echocardiogram (TEE)! My cardiologist was out of town, but her associate said he saw a “shadow” near my heart valve that indicated an abscess, and I was immediately admitted to the hospital and put on IV antibiotics to kill the bacteria. Blood was taken twice to culture and find out what the bacteria was. I was told it would take days to culture the blood, and that I would have to be in the hospital a minimum of four days, and that leaving the hospital with a heart infection could be a disaster if some of this “flaked” off before they got the infection under control.

Needless to say, this was a very scary time…my husband was out of the country – I had to call my mom from out of state to come take care of my children, and enlist the help of neighbors until she could get to my home.

I will shorten this story to say that last night, after 24 hours in the hospital, the contagious disease doctor came to my room and asked me if I wanted to go home! It turns out that the “shadow” seen around my valve was not an abscess, but a normal part of the valve which my heart surgeon confirmed when they finally got around to having him look at the results of the TEE. The high fever, cough and congestion was caused by H1N1, although I tested negative for it with the quick test. The more comprehensive test showed that I was positive. At this point, I was not contagious as I had been fever free for 24 hours.

So, I am home, grateful to not have endocarditis, and trying to see the silver lining in this crazy roller coaster ride. This is what I learned:

  1. ALWAYS take a fever very seriously if you have had a valve replacement. It could mean endocarditis, so call your heart doctor.
  2. The quick test for H1N1 can register a false negative, so request the longer test if you are unsure of what is causing your fever.
  3. Make sure your heart surgeon becomes involved in all diagnosis of any illness you have that might involve your heart.
  4. Make sure you always pre-medicate with an antibiotic prescribed by your doctor before any dental work.

I am glad that my story ended with a happy ending… just wish I had not been put through this crazy ride!

Sarah Hester
Aortic Valve Replacement, 9/2/2008

Adam Pick
Written by Adam Pick

Adam Pick is a patient, author of The Patient's Guide To Heart Valve Surgery and the founder of HeartValveSurgery.com.

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  • Stephen Waxman

    I am 58 years old and I have had my aortic valve replaced twice at the University of Ottawa Heart Institute (Ottawa Canada). I contacted bacterial endocarditis on both occasions prior to surgery from routine dental procedures. My second replacement took place in November 1988 and since that time my cardiologist has been adamant that I receive IV antibiotic drug treatment prior to and six hours after the dental procedure.

    My message to all valve patients is to be very careful that you are properly medicated prior to any dental procedure.Take it from me, it may save your life.!!!!!

    Stephen Waxman,
    Ottawa (Canada)

  • Rhena Smith

    I read this with interest, but for well over a year now, my dentist and cardiologist have both concurred that clinicals studies have shown that prophylactics are no longer required due to a murmur. I have not had my Aortic Valve replaced as yet – but will one day per my cardio. The Dentist did make a point of telling me that once I do have my valve replaced – then they will require anti-biotics always.

    If I were to have some dental surgery now (not just routine dental work), I think my Dentist would prescribe anti-biotics. In any case, he has always made it clear that he will prescribe them if it makes me feel more comfortable. Since I don\’t like taking anti-biotics unless necessary, I have declined in the past. This story is alarming though, so maybe I should ask for them anyway.

  • Kerrigan

    My dentist and cardiologist with Kaiser said “inclusive results” from the study (to them) said “keep taking pre-meds for any procedure which involves invasion of the body” with instruments, etc.

  • Richard Holoubek

    I would like to throw out a question for general discussion… Is there a risk of bacterial infection from just flossing your teeth?…. or picking at your teeth with a toothpick?

  • Debbie

    I’m havingmy aortic valve surgery this November. Although, the recommendation is now that we do not need pre-med the experts are tellingme to continue it. Stating “Not going to hurt you and may help”. Kepp it in mind of they tell you it’sno longer needed.

  • Midge

    Richard, had aortic valve replacement in Feb. 09. I floss daily and use toothpicks every day. I think as long as you aren’t making your guns bleed, you are okay. If you gums start bleeding, I would consult cardio.

    Also, I vote for antibiotics before dental work. Have my first dental checkup and cleaning since surgery in a couple weeks and will ask cardio or dentist for antibiotics beforehand. Even before my surgery, my cardio told me endocarditis is something I do not want to get post surgery and it is wish to pre-med even if it’s no longer considered necessary. This is the only body we have and I’d rather have a dose or two of unneeded antiobiotics than run the risk of fighting off endocarditis.

    Midge

  • Dan

    Sara

    I have a story that begins with endocarditis and the hospital stay to disinfect the blood , next home with a PIC line incerted in my chest to admin a 6 week twice a day regimint of Anitbiotics which at one point put me a 0 White blood cell count so into emergency for change of RX , then at week 4 a seizure so off in an ambulance for an aneurisym probably from the flaked away vegitation you mentioned then finally at week 6 a mitral valve repair/replacement from damage the bacteria caused
    and I am still left with a weekened vein in my cerrabellum brain.

    Now I wonder how the swine flu will play into all this

  • Kebe

    Dear Adam, I am a candidate for an aortic valve replacement sometime in November, 2009. I am in a dilemma to decide which type of valve to be replaced. I am 55 years of age and have no other health issues.
    My problem with the mechanical valve will be how often I have to be pricked to get the blood out for INR testing. Will that be really a big concern as it looks for me at this moment? How often should the test be done?
    I cannot decide on the Tissue valve as it does not last long.
    I will appreciate your helpful comment.

  • Jana

    my best friend contracted endocarditis summer of 08. He did have dental work 6 months prior and became ill early that summer (May?). I think this was a severe case as that most cases are caught much early on. His doctors kept treating him for the flu. I think because of his weight and determination to work hard he stayed alive until his temperature rose to 105 and his body shook so badly from the infection that he finally collasped. He was admitted to the hospital around July 31-Aug 1 where it took the doctors a few days to figure out what was wrong. They even misdiagnosed him with Lukemia! The best test was the bacteria in the blood test (it took 24-48 hours for results). He had to have his aortic valve replaced on August 8, 08. The surgery became an emergency due to how far along the endocarditis had attacked his system so I’m sure the doctors tried to explain as much as they could in little time but a couple things they didn’t tell him (and his the family)…. They didn’t tell him that the valve makes a tick tick tick all the time, like a pocket watch. even people standing in the same room as he can hear it at times. I happen to enjoy placing my ear to his heart and hear him ticking, It’s kind of cool in the sense it is a reminder that he survived. But he has said he enjoys listening to my heart once in awhile and wishes the ticking wouldn’t be so loud at times in his head. He is about 6 ft 4 and 240 lbs. (the endocardistis caused him to lose a lot of weight, he went from 275 down to 175).

    Now my mom in law had the same procedure and same St Jude valve replacement as my friend, just a few years prior to him, she doesn’t even really notice the ticking. She is approx 5 ft 4 and 200. She did not have endocarditis. I don’t know why she needed the replacement.

    neither one seem to have much or any chest pain It took some getting used to in the beginning but now they both don’t mind going in to the clinic every month for an INR check. However, my friend has to pay a $20 co pay every time and that gets tiring.

    The wiring stays forever. it’s cool yet weird on x-rays.

  • Midge

    Kebe, I went with a mechanical valve at age 67. It just felt right for me. Yes, I will be on Coumadin for the rest of by life but that’s not a huge deal. If you go to a lab for blood work, they will actually do a needle stick, not a prick. There are home testing kits available that many use and many insurances will cover them. They usually allow you to test once a week (but for the first 3 months you have to go to a lab…the device makers won’t give you one until after 3 months).

    I had my surgery in Feb. and first went every 3 – 4 days, then once a week and then once every two weeks and finally I’m down to once every 4 weeks, which is pretty standard. It’s not as bad as it sounds!

    Also, I have never heard my valve click or tick once. Guess that’s a stroke of luck. Anyway, mechanical valves usually avoid the possibility of another surgery and that was paramont in my mind.

    Good luck on your decision. This is one of the hardest decisions you will have to make, most everyone agrees, but it’s your valve so pick what works for you.

    Midge

  • Bill

    Anytime you brush, floss or work on your mouth it s not uncommon to have bleeding. When you bleed you open the door for bacteria to enter the bloodstrem and potentially the heart. For the most part, studies have shown that profolactic antibiotics just do not produce the protection that many thought it would. Your bodys own immune system seems to look after itself quite well, but not 100% of the time! It all boils down to risk vs benefit. Talk with your heart specialist about your risk vs benefit need to pre-med. Also try a germ killing mouthwash prior to doing anything to your mouth.

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