> I am a 62 year old woman just diagnosed with MVP by echocardiography-
> though I had one 4 years ago that was normal, revealed no prolapse. The
> MVP is considered to be mild, to at most, moderate. I know this question
> sounds a little uniformed, but I have had a lot of dental work,
> gingivectomy, an extraction, in the past year before diagnosis without
> antibiotic. Is it possible to get endocarditis and not know it? There were
> never any signs of infection. Also, can one get MVP from a bad cold, from
> flu? In other words, how is it acquired. This whole thread is interesting
> to me; I have been told for20 years that I had "athlete’s heart," although
> the echo showed it to be of normal size.

I don’t think you can get endocarditis and not know it. As I said in an
earlier message, my husband has had 4 bouts of it since 1983 and is
currently recouperating from a mitral valve replacement.  
His symptoms started like flu; general achy feelings, lethargy, then fever
that spikes up to 103 or more, then when you take it 20 minutes later it’s
normal, then back up. First time he had it we threw away good therm.
because we thought it was bad. Thank God our family dr. at that time had
been reading recently about endocarditis and his brain sent up a flag when
I showed him my chart of temps over a 12 hour period.
Barb

–
Barb Wilkison
wilk…@citizen.infi.net

> Thank you in advance for your help.

> R.

Ralph…Listen to your dentist!!!! My husband is currently in the
hospital, had his mitral valve replaced last Wednesday.  Since 1983 he has
had 4 occurrances of bacterial endocarditis. It’s been a year getting this
last one under control. Each time it gets more resistant to antibiotics.
Each time he’s gotten it has been within several months of dental work.
First time he didn’t know about the pre-medication recommendations. The
more recent times he medicated heavily both before and after, but got it
anyway. His system just couldn’t fight it off. He can’t remember and he’s
adopted and birth parents are deceased, but doctors seem to think he must
have had rheumatic fever as a young child. He had valve prolapse, then
regurgitation kept getting worse.  Endocarditis kept attacking the valve
and finally damaged it beyond repair. Save yourself trouble and possibly
your life…take the meds!
Barb

–
Barb Wilkison
wilk…@citizen.infi.net

If you had endocarditis, you would know it.  You would be quite ill and
would probably see your physician due to numerous nonspecific
symptoms—including fevers, night sweats, lethargy, shortness of breath,
maybe a "rash", edema, etc., etc.  The last patient I saw had these
symptoms for a month (he was pretty stoic), but he’s doing well now after
a valve replacement.

To name just a couple of examples of how mitral regurgitation (not mitral
valve prolapse) is acquired:  MR might be acquired if the left ventricle
enlarges, as with remodelling after a heart attack or with a
cardiomyopathy; alternatively, the chords which tether the valve can
break after years of wear and tear; or the muscles that attach to the
chords can malfunction with ischemia or after a heart attack.

Hope this helps.  A., Fellow, Creighton Cardiac Center

- Hide quoted text — Show quoted text -

>I am a 62 year old woman just diagnosed with MVP by echocardiography-
>though I had one 4 years ago that was normal, revealed no prolapse. The
>MVP is considered to be mild, to at most, moderate. I know this question
>sounds a little uniformed, but I have had a lot of dental work,
>gingivectomy, an extraction, in the past year before diagnosis without
>antibiotic. Is it possible to get endocarditis and not know it? There were
>never any signs of infection. Also, can one get MVP from a bad cold, from
>flu? In other words, how is it acquired. This whole thread is interesting
>to me; I have been told for20 years that I had "athlete’s heart," although
>the echo showed it to be of normal size.

[Big snip...]

>There has been a great deal of discussion and argument about this, but
>the fact remains that taking 1 or 2 doses of an antibiotic is a small
>premium to insure against the risk of a potentially fatal (and certainly highly
>inconvenient and prolonged) infection.  From the point of view of the physician
>& dentist, antibiotic prophylaxis for significantly abnormal or variant valves
>is regarded as sufficiently scientifically based to guarantee an instant
>indefensible lawsuit should endocarditis occur when it has been omitted.

>David Rollo

Is this subacute bacterial endocarditis that’s being discussed here?
If so, I can’t locate any journal articles tieing this in with
dentistry.  Anyone with a reference to JADA?

I would like to know about the meaning of the phrase "significantly
abnormal or variant valves".  It would seem that we would be
referring to the mechanical action of the valve as it opens and
closes (murmer?), not the rate at which it operates (arrhythmia?)?

     Mark     gmt1…@msu.oscs.montana.edu   msu-bozeman   USA

>(snip)
>….. Now, just because some dentist told you about
>the potential risk, you pre-medicate before all dental work?
>With all due respect, it’s going to take a hell of a lot more
>than your or some other doctor’s or dentist’s opinion on this
>before I’m convinced that it’s not overkill or downright
>unecessary.  How about some data on the risks?
>R.

Dear Ralph,

It seems like you have made up your mind regarding this problem before
asking the news group. I don’t understand your motives. You asked for
help, people gave you sufficient answers. Now you say you don’t
believe it and you want data. Well sir, it’s not our job to give you
research data,  THAT’S YOUR JOB. Do your home work, go to a local
library or the nearest medical school library and look up the problem.
If you don’t believe your dentist or MD, then you need to do your own
research.

I did not answer before because you touched on a nerve for me. I just
lost a very close uncle to bacterial endocarditis. He was 44 with 4
kids, all still in school. You see, a wise man once said:

It’s  little knowledge that will kill you. You’d be safe with none or
a lot of knowledge. (Translated from another language, that’s why it
sounds weird, but you get the drift, don’t you).

So please wise up and listen to your doctors, if not for yourself,  do
it for your family. Taking a few pills to avoid a tragedy is a minor
inconvenience.

Again, please go to a library (or even on the NET) and do your own
research.

Best regards and good luck,

YDFW

Joan

Dear Joan,
What is your problem!?!?!?!?!?  SBE is a serious condition.  It almost
killed me at age 21!!!!!  Your attitude is amazing.  If this were not the
internet and I not a lady I would tell you in more explicit terms just how
sick your statement makes me.
You need to be educated before you make statements that strong.
Sincerely,
Lisa Salberg
Founder HCMA
LFAS1…@aol.com Lisa Salberg

- Hide quoted text — Show quoted text -

> I have never in my life pre-medicated before having any dental
> work done and have no desire to have antibiotics flowing
> throughout my system looking for an infection to attack.  I’ve
> also had a couple of minor surgeries done (removal of sebaceous
> cysts) and have never suffered any infections as a result of them.

> My questions include 1) is one born with MVR or can it be
> acquired?, 2) what is the probability that the echocardiograph (or
> the doctor reading it) could have been wrong? (I’ll probably get a
> second opinion soon.), 3) what is the probability of a healthy 38
> year-old male with MVR contracting a heart infection from a dental
> cleaning?, 4) why wouldn’t any minor injury that resulted in
> bleeding present the same risk in persons with MVR?, and 5) why
> wouldn’t other tissue also be susceptible to infection from a
> dental cleaning or minor surgery in persons with MVR?

> Getting answers from my doctor is like pulling teeth.

> Thank you in advance for your help.

> R.

I am a 62 year old woman just diagnosed with MVP by echocardiography-
though I had one 4 years ago that was normal, revealed no prolapse. The
MVP is considered to be mild, to at most, moderate. I know this question
sounds a little uniformed, but I have had a lot of dental work,
gingivectomy, an extraction, in the past year before diagnosis without
antibiotic. Is it possible to get endocarditis and not know it? There were
never any signs of infection. Also, can one get MVP from a bad cold, from
flu? In other words, how is it acquired. This whole thread is interesting
to me; I have been told for20 years that I had "athlete’s heart," although
the echo showed it to be of normal size.

        Is the patient being treated, or is the DDS’s fear of malpractice
being treated?

Joan

>Getting answers from my doctor is like pulling teeth.
>R.

If your physician can’t give you the answers you need, you need another
physician.  Based on the limited information you have given, let me try
to  very briefly answer your questions:  MR can be acquired under
numerous circumstances; one can also be born with it.  It would be
unusual to misdiagnose MR on an echo, although the severity could be
mis-calculated—usually underestimated on a transthoracic study.  The
probability of contracting endocarditis really depends on the etiology of
the MR; some types are worse than others.  Dental work (or colonoscopy,
etc.) poses a larger risk because of the bacteria that reside in the
mouth (or colon, etc.), and because of the risk of "seeding" the blood
with bacteria.  The valve tissue is more susceptible because it is
presumably abnormal (whether scarred, or redundant, or malformed) and
because of the turbulent blood flow through the orifice, which assists
the bacteria in "sticking to" or seeding the valve.  Please either talk
this over with your M.D., or get a second opnion—endocarditis can be
life-threatening.  A., Fellow, Creighton Cardiac Center

There are occasional SMALL showers of bacteria (after straining at
stool or brushing teeth, for example), but people with smooth
endovascular surfaces, no foreign bodies, and normal immune competence
can clear these out.  People with vascular oxbows and backwaters
(e.g., people with heart valves abnormal enough to be noisy), are not
so resistant, especially to the BIG showers of bacteria that sometimes
accompany dental work.