Materiały źródłowe

• #1 Understanding Heart Valve Disease

  https://premierheartandvascular.com/understanding-heart-valve-disease/

  Heart valve disease is a name given to conditions in which one or more of your four heart valves don’t function properly. If your valves do not open or close properly, the blood flow from your heart to the rest of the body is disrupted. […] In this article, we’re sharing what causes heart valve disease and all the prevention methods and tips available to you. […] Prevention depends largely on what causes the disease; however, physical activity, a healthy diet and an overall healthy lifestyle promote heart health, which, in turn, may protect against heart valve disease. […] An overall healthy lifestyle works well not only for this disease but also for other problems: Heart attacks, high blood pressure and other heart-related problems occur much less frequently in individuals who lead a healthier life. […] If you’ve had rheumatic fever, a heart attack or an endocarditis infection, it’s vital to visit your doctor, who can counsel you on heart valve disease prevention options.

• #2 Heart valve disease — symptoms, causes, treatment | healthdirect

  https://www.healthdirect.gov.au/heart-valve-disease

  You can help prevent heart valve disease by having a healthy lifestyle, such as by eating healthily, keeping a healthy weight, limiting alcohol, quitting smoking and sleeping well. […] You can help prevent heart valve disease from developing or worsening by having a healthy lifestyle, such as by: being physically active, eating a healthy diet, trying to maintain a healthy weight, quitting smoking, limiting alcohol, getting enough sleep. […] Prevention focuses on lifestyle changes because many things causing heart valve disease happen because of lifestyle factors.

• #3 Heart Valve Disease: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17639-what-you-need-to-know-heart-valve-disease

  How can I reduce my risk of heart valve disease? […] Although you cant change some risk factors, like growing older, there are things you can do that may reduce your risk of heart valve disease. These include: […] Getting treatment quickly for infections […] Being physically active […] Eating heart-healthy foods […] Staying at a weight thats healthy for you […] Continuing to take medicine for high blood pressure and/or high cholesterol if you have those conditions […] Not using tobacco products […] Not using recreational drugs, especially IV drugs, which increase your risk for heart valve infection. […] If you have heart valve disease, ask your healthcare provider about the increased risk of getting infective endocarditis. This infection can damage or destroy your heart valves and can be fatal. Youre at risk even if you had surgery to repair or replace your valve. To prevent infective endocarditis:

• #4 About Heart Valve Disease | Heart Disease | CDC

  https://www.cdc.gov/heart-disease/about/heart-valve-disease.html

  People may help to reduce their risk for heart valve disease by: […] Making heart-healthy choices by: […] Choosing heart-healthy foods, such as fresh fruits and vegetables. […] Following CDC physical activity guidelines for heart health. […] Managing stress. […] Getting to know your heart health by: […] Getting annual physical checkups, including having a health care professional listen to your heart with a stethoscope. […] Letting your health care team know if you have noticed changes in your heartbeat. […] Taking care of your overall health by: […] Having a good daily oral hygiene routine and getting regular dental checkups to reduce risk of heart infection. […] Getting treatment for respiratory infections such as strep throat. […] Taking antibiotics as instructed to prevent infection (such as when they are prescribed before surgery or dental procedures).

• #5 How to strengthen heart valves: Diet, exercise, and more

  https://www.medicalnewstoday.com/articles/how-to-strengthen-heart-valves-naturally

  Individuals can help strengthen their heart valves through dietary changes, regular exercise, and managing blood pressure. […] However, appropriate lifestyle modifications can help maintain strong heart valves. […] The Centers for Disease Control and Prevention (CDC) recommend limiting the intake of processed foods and eating various fresh vegetables and fruits to prevent heart disease. […] Limiting sugar intake also helps prevent diabetes, a known risk factor for heart disease. […] The CDC also recommends limiting salt and alcohol intake to control blood pressure, which can damage the heart valves. […] The CDC also notes that regular exercise is important for preventing heart disease. […] Physical activity can help a person maintain healthy blood pressure, blood cholesterol, and blood sugar.

• #6 Heart valve disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/heart-valve-disease/diagnosis-treatment/drc-20353732

  If you have heart valve disease, your health care team may suggest making lifestyle changes. Try these steps: […] Eat a heart-healthy diet. Eat a variety of fruits and vegetables, low-fat or fat-free dairy products, poultry, fish, and whole grains. Avoid saturated and trans fats and excess salt and sugar. […] Get regular exercise. As a general goal, aim for at least 30 minutes of moderate physical activity every day. Talk to your health care team before starting a new exercise routine. […] Maintain a healthy weight. Being overweight raises the risk of heart problems. Talk with your care team to set realistic goals for weight. […] Don’t use tobacco. If you smoke or chew tobacco, quit. Smoking is a major risk factor for heart disease. Quitting is the best way to reduce the risk. If you need help quitting, talk to a health care professional.

• #7 Heart Valve Diseases – Causes and Risk Factors | NHLBI, NIH

  https://www.nhlbi.nih.gov/health/heart-valve-diseases/causes

  You can take steps to help prevent some causes of congenital heart valve disease, although not all are preventable. Talk to your doctor about any vitamins you may need and how to avoid infections such as rubella during pregnancy. […] Your doctor may also talk to you about steps you can take to lower your risk for acquired heart valve diseases. […] Make heart-healthy lifestyle changes. These include eating a heart-healthy diet, being physically active, aiming for a healthy weight, quitting smoking, and managing stress. […] Practice good skin and dental hygiene. This can help protect you from infections that cause endocarditis, a type of heart inflammation that can damage the heart valves. […] Take medicines as prescribed to prevent a heart attack, high blood pressure, or heart failure. If you have strep throat, finish all of your prescribed medicine to treat it. This helps prevent rheumatic fever, which can damage the heart valves.

• #8 Overview of Valvular Heart Disease | Pantai Hospital

  https://www.pantai.com.my/medical-specialties/cardiology/valvular-heart-disease

  Lower your risk by leading a healthy lifestyle. Follow these simple tips: […] Quit smoking […] Get physically active […] Maintain a healthy weight […] Eat a healthy diet […] Reduce alcohol consumption […] Manage your stress.

• #9 Heart Valve Disease Prevention: Key Strategies – Acibadem Health Point – ACIBADEM Hospitals – Acibadem Health Group

  https://www.acibademhealthpoint.com/heart-valve-disease-prevention-key-strategies/

  Getting regular checkups helps a lot in preventing heart valve complications. It catches heart valve diseases early. Then, doctors can start the right treatments fast. This makes things turn out better for patients. […] Smoking is really bad for your valve health. It makes your arteries hard. This is called atherosclerosis. It can hurt your valves and make you more likely to get heart valve disease. Smoking also makes your blood carry less oxygen. This makes your heart valves work harder. […] Chronic stress makes our blood pressure and heart rate go up. This is bad for our heart valves. Doing things to reduce stress is key to keeping your heart and valves healthy. […] Knowing about genetic factors in valve disease helps a lot with your heart’s health. It’s key to look at your family’s health to see if heart problems might run in your family. This way, you can act early to stay healthy.

• #10 Preventing Heart Valve Disease – Lakeview Cardiology of Texas

  https://lakeviewcardiologytexas.com/2023/12/14/preventing-heart-valve-disease/

  Monitor blood pressure regularly and take necessary steps to keep it within a healthy range. […] Control blood sugar levels through lifestyle modifications, medication, and regular monitoring. […] Schedule regular check-ups with healthcare providers to assess overall cardiovascular health. […] Adopt stress-reducing techniques such as mindfulness, meditation, or yoga to promote emotional well-being. […] If prescribed medications for cardiovascular conditions, adhere to the prescribed regimen.

• #11 Heart valve disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/heart-valve-disease/diagnosis-treatment/drc-20353732

  Practice good sleep habits. Poor sleep may increase the risk of heart disease. Adults should aim to get 7 to 9 hours of sleep daily. Go to bed and wake at the same time every day, including on weekends. If you have trouble sleeping, talk to your health care team about strategies that might help. […] Control blood pressure. Uncontrolled high blood pressure increases the risk of serious health problems. Get your blood pressure checked at least every two years if you’re 18 and older. If you have risk factors for heart disease or are over age 40, you may need more-frequent checks. […] Get a cholesterol test. Get a baseline cholesterol test when you’re in your 20s and then at least every 4 to 6 years. Some people may need to start testing earlier or have more-frequent checks. […] Manage diabetes. If you have diabetes, tight blood sugar control can help keep your heart healthy.

• #12 How to strengthen heart valves: Diet, exercise, and more

  https://www.medicalnewstoday.com/articles/how-to-strengthen-heart-valves-naturally

  A 2018 study of 5.4 million United Kingdom adults found that long-term elevated blood pressure increases a persons risk for aortic valve stenosis or aortic valve regurgitation. […] High blood pressure increases someones risk for coronary heart disease and stroke. […] The CDCs recommendations for managing blood pressure include: getting at least 2.5 hours of moderate to intense physical activity per week, eating a nutritious diet that consists of a variety of vegetables and fruit, limiting alcohol intake, which can affect heart health, avoiding smoking, which can further raise the risk of heart attack or stroke, keeping track of blood pressure measurements, managing diabetes by controlling blood glucose, taking prescription blood pressure medications as a doctor prescribes. […] A person can help keep their heart valves in healthy working order by following the above health tips, including: eating a nutritious diet, getting daily, moderate-intensity exercise, keeping blood pressure in check, avoiding smoking, if applicable. […] A person can naturally maintain heart valve health by eating a heart-healthy diet, exercising regularly, not smoking, and managing blood pressure.

• #13 Key to aortic valve disease prevention: Lowering cholesterol early | ScienceDaily

  https://www.sciencedaily.com/releases/2014/10/141027120501.htm

  Key to aortic valve disease prevention: Lowering cholesterol early […] New evidence has been uncovered that aortic valve disease may be preventable. […] Their findings show that so-called „bad” cholesterol or low-density lipoprotein-cholesterol (LDL-C) is a cause of aortic valve disease — a serious heart condition that affects around five million people in North America and is the most common cause for valve replacement. […] Our work provides confirmation that cholesterol is an important factor in the early stages of aortic valve disease and suggests that lowering cholesterol early in the disease process may provide protection from the development of aortic valve disease.

• #14 Heart Valve Disease | Atrium Health Wake Forest Baptist

  https://www.wakehealth.edu/condition/h/heart-valve-disease

  At Atrium Health Wake Forest Baptists Heart and Vascular Center, we emphasize heart health and disease prevention. […] Living a heart-healthy lifestyle and undergoing regular heart screenings can greatly lower your risk for developing heart disease. […] A heart-healthy diet can help to prevent heart disease, or conditions that may lead to heart disease, such as high cholesterol, high blood pressure and obesity. […] Weight management is an important part of heart disease prevention. Eating a healthy diet and exercising are the best ways to control your weight. […] Regular heart screenings can enable your doctor to diagnose any heart condition in its early stages.

• #15 Heart Valve Disease Prevention | Vital Heart & Vein

  https://vitalheartandvein.com/news/heart-valve-disease-prevention/

  Heart valve disease is more common in those over the age of 55. […] You can start by visiting your doctor and maintaining regular checkups. […] You should also cultivate a heart healthy lifestyle including regular physical activity and a balanced diet. […] There are some medicines aimed at preventing heart valve disease by improving blood flow, lowering cholesterol, and alleviating symptoms of heart disease. […] Through regular checkups, a nutritious diet, and consistent exercise, you can help do your best to keep your heart healthy.

• #16 Patient education: Antibiotics to prevent heart valve infections (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/antibiotics-to-prevent-heart-valve-infections-beyond-the-basics/print

  People who are at increased risk of infections of the heart valves (a condition called infective endocarditis [IE]) need to take an antibiotic before certain dental or other invasive medical procedures. Taking a preprocedure antibiotic to prevent infection is called „antibiotic prophylaxis.” […] Most experts believe that taking antibiotics before selected dental procedures has benefit (which outweighs the risk of antibiotics) only for people who are at highest risk of adverse outcome from IE. Your health care provider can help you understand your risk of developing IE; whether you might benefit from preventive antibiotics or whether the risk of an adverse effect of an antibiotic may outweigh its potential benefit. […] Preventive antibiotics before certain procedures are generally recommended for people who are considered to be at highest risk of adverse outcome from IE, including those with the following conditions: A prosthetic heart valve or past valve repair with prosthetic (man-made) materials, A prior history of IE, Certain types of congenital heart disease, Cardiac transplantation with presence of heart valve abnormalities, Durable mechanical circulatory support device (ventricular assist device or artificial heart).

• #17 Prevention of endocarditis: Antibiotic prophylaxis and other measures – UpToDate

  https://www.uptodate.com/contents/prevention-of-endocarditis-antibiotic-prophylaxis-and-other-measures

  Prevention of endocarditis: Antibiotic prophylaxis and other measures […] Measures for prevention of infective endocarditis (IE) are discussed here, including the clinical approach and rationale for antibiotic prophylaxis prior to dental procedures. […] Measures for prevention of IE include: […] – Maintenance of oral hygiene. […] – Antibiotic prophylaxis prior to invasive dental or invasive oral procedures. […] – Timely treatment of infections with pathogens likely to cause endocarditis. […] – Antibiotic prophylaxis prior to surgery reduces the risk of surgical site infection, as discussed separately, and has been postulated to reduce the risk of subsequent endocarditis. A key example of this approach is antibiotic prophylaxis prior to cardiac surgery. […] – Closure of a patent ductus arteriosus or ventricular septal defect.

• #18 Infective Endocarditis | American Heart Association

  https://www.heart.org/en/health-topics/infective-endocarditis

  Antibiotic prophylaxis is reasonable before the above-mentioned dental procedures for people with heart conditions who have any of the following: […] Antibiotic prophylaxis may be reasonable for certain medical procedures on the respiratory tract or infected skin, skin structures or musculoskeletal tissue for adults with underlying heart conditions associated with the highest risk of poor outcomes from IE. […] You can help reduce the risk of IE by maintaining good oral health through regular professional dental care and the use of dental products such as manual, powered and ultrasonic toothbrushes; dental floss; and other plaque-removal devices. […] Your health care team can provide you with more information and answer your questions about preventing IE.

• #19 Prevention of endocarditis: Antibiotic prophylaxis and other measures – UpToDate

  https://www.uptodate.com/contents/prevention-of-endocarditis-antibiotic-prophylaxis-and-other-measures

  Maintenance of oral hygiene is important to reduce the risk of gingivitis and periodontitis as well as the risk of bacteremia. 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. […] Antibiotic prophylaxis is warranted for patients with cardiac conditions that confer the highest risk of adverse outcome from IE prior to invasive dental or invasive oral procedures. […] Antibiotic prophylaxis prior to surgery reduces the risk of surgical site infection, as discussed separately, which may reduce the risk of subsequent endocarditis. A key example of this approach is antibiotic prophylaxis prior to cardiac surgery.

• #20 Canadian Dental Association

  https://www.cda-adc.ca/en/about/position_statements/infectiveendocarditis/

  The Canadian Dental Association (CDA) supports the American Heart Association (AHA) recommendations that only patients at greatest risk of an adverse outcome from infective endocarditis, an infection of the hearts inner lining or heart valves, require antibiotic prophylaxis prior to certain dental procedures. […] The recommendations, which are outlined in the 2007 AHA Guideline on Prevention of Infective Endocarditis, emphasize that most patients with a history of cardiac health issues do not need routine preventive antibiotics before a dental procedure. […] To reduce the risk of infective endocarditis, the AHA guidelines emphasize the importance of maintaining excellent oral health through regularly scheduled dental visits and daily oral hygiene, which decreases the incidence of bacteremia associated with daily activities.

• #21 British Heart Valve Society update: a change in the NICE guidelines on antibiotic prophylaxis – The British Journal of Cardiology

  https://bjcardio.co.uk/2016/08/british-heart-valve-society-update-a-change-in-the-nice-guidelines-on-antibiotic-prophylaxis/

  Staff in general practices and specialist valve clinics should emphasise that good oral hygiene and regular dental review are as important as antibiotic prophylaxis, if not more so, in reducing the risk of IE. The European Society of Cardiology (ESC) recommend10 strict dental and cutaneous hygiene with regular dental surveillance. It is also important to educate patients at risk in recognising the possibility of IE. Typically, there may be persistent night sweats, general malaise and weight loss. At least two sets of blood cultures should be taken before starting antibiotics. […] Antibiotic prophylaxis: indicated for people at high risk having high-risk dental procedures. Record details of consent process in the dental notes. Use amoxicillin 3 g or clindamicin 600 mg orally one hour before. […] Other advice: dental surveillance six monthly (high-risk people) or annually (medium-risk people), avoid tattoos and intravenous drug use.

• #22 Heart Valve Disease: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17639-what-you-need-to-know-heart-valve-disease

  Tell your medical and dental providers that you have valve disease […] Call your provider if you have symptoms of an infection […] Take good care of your teeth and gums […] Ask your cardiologist if you should take antibiotics before any dental procedures, major or minor surgeries or invasive tests.

• #23 Prevention of endocarditis: Antibiotic prophylaxis and other measures – UpToDate

  https://www.uptodate.com/contents/prevention-of-endocarditis-antibiotic-prophylaxis-and-other-measures

  For patients with history of IE with successfully closed PDA or VSD should continue to receive antibiotic prophylaxis prior to dental procedures. […] Preventive measures to reduce the risk of infective endocarditis (IE) include: […] – Maintenance of oral hygiene. […] – Timely treatment of infections with pathogens that cause endocarditis. […] – Antibiotic prophylaxis prior to invasive dental or invasive oral procedures. […] – Antibiotic prophylaxis prior to surgery reduces the risk of surgical site infection, as discussed separately, which may reduce the risk of subsequent endocarditis. […] – Closure of a patent ductus arteriosus (PDA) or ventricular septal defect (VSD). […] Antibiotic prophylaxis prior to invasive dental or invasive oral procedures is warranted only for patients with conditions or implanted devices associated with the highest risk of an adverse outcome if IE occurs.

• #24 Indications for antibiotic prophylaxis to prevent infective endocarditis in adults

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Indications-for-antibiotic-prophylaxis-to-prevent-infective-endocarditis-in-adults

  The European Society of Cardiology recommend antibiotic prophylaxis to prevent infective endocarditis in patients undergoing high-risk procedures who are at high risk from infective endocarditis. […] The current ESC guidelines recommend that AP should be considered for individuals thought to be at high risk of IE when undergoing high-risk dental procedures. […] The ESC defines three patient groups as being at high risk of IE. These groups are: Patients with a prosthetic valve, or where prosthetic material has been used to repair a valve. […] The class of evidence is given as IIa, the level of evidence as C. Class IIa is defined as The weight of evidence/opinion is in favour of usefulness/efficacy. Level of evidence C is defined as Consensus opinion of the experts and/or small studies, retrospective studies, registries.

• #25 Antibiotic Prophylaxis for Heart Patients | MouthHealthy – Oral Health Information from the ADA

  https://www.mouthhealthy.org/all-topics-a-z/antibiotic-prophylaxis-for-heart-patients

  Antibiotic prophylaxis is recommended for a small number of people who have specific heart conditions. The American Heart Association has guidelines identifying people who should take antibiotics prior to dental care. According to these guidelines, antibiotic prophylaxis should be considered for people with: […] Artificial heart valves. […] A history of an infection of the lining of the heart or heart valves known as infective endocarditis, an uncommon but life-threatening infection. […] A heart transplant in which a problem develops with one of the valves inside the heart. […] Heart conditions that are present from birth, such as: […] Unrepaired cyanotic congenital heart disease, including people with palliative shunts and conduit. […] Defects repaired with a prosthetic material or devicewhether placed by surgery or catheter interventionduring the first six months after repair. […] Cases in which a heart defect has been repaired, but a residual defect remains at the site or adjacent to the site of the prosthetic patch or prosthetic device used for the repair.

• #26 Patient education: Antibiotics to prevent heart valve infections (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/antibiotics-to-prevent-heart-valve-infections-beyond-the-basics/print

  People who are at highest risk for IE should take one dose of an antibiotic before certain dental, oral, or upper respiratory tract procedures. For these people, preventive antibiotics are recommended for routine dental cleanings as well as more invasive procedures such as tooth extractions, abscess drainage, or root canals.

• #27 British Heart Valve Society update: a change in the NICE guidelines on antibiotic prophylaxis – The British Journal of Cardiology

  https://bjcardio.co.uk/2016/08/british-heart-valve-society-update-a-change-in-the-nice-guidelines-on-antibiotic-prophylaxis/

  The National Institute for Health and Care Excellence (NICE) has made an important change to Clinical Guideline 64 (CG64)1 adding the word routinely to Recommendation 1.1.3: Antibiotic prophylaxis against infective endocarditis is not recommended routinely for people undergoing dental procedures. In a letter about the change,2 Sir Andrew Dillon, CEO of NICE, confirmed that in individual cases, antibiotic prophylaxis may be appropriate. […] Prophylaxis should be with amoxicillin 3 g by mouth one hour before the procedure or, for patients with penicillin hypersensitivity, clindamicin 600 mg orally. Adverse effects from oral amoxicillin prophylaxis are uncommon with no deaths reported in Europe since records began.8 Clindamicin has a slightly higher level of risk.9 Both are cost-effective in high-risk patients having high-risk dental procedures.8

• #28

  https://bpac.org.nz/bpj/2015/june/endocarditis.aspx

  Amoxicillin is the first-line prophylactic antibiotic for people undergoing invasive dental procedures who are at high risk of developing endocarditis. […] To ensure that levels in the blood are maximal at the time of procedure, the antibiotic should be given in the following timeframes: Orally, one hour before the procedure; Intramuscularly (IM), 30 minutes before the procedure; Intravenously (IV), immediately before the procedure. […] In addition to when invasive dental procedures are performed, people who are at high risk of developing infective endocarditis also require prophylactic antibiotics if they undergo surgery at an anatomical site that is actively infected; if major surgery is planned, a prophylactic antibiotic is likely to be administered anyway. […] The principle reason for the reduction in antibiotic use was that the risk of a person developing infective endocarditis following a dental procedure is very low, even for those with a high lifetime risk. […] In 2008, the United Kingdom National Institute for Health and Care Excellence (NICE) went one step further than other groups and recommended that antibiotics should no longer be prescribed solely for the prevention of infective endocarditis, regardless of the patients risk.

• #29 AHA Releases Updated Guidelines on the Prevention of Infective Endocarditis | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0215/p538.html

  The AHA no longer recommends antibiotic prophylaxis based on an increased lifetime risk of infective endocarditis. No data prove that antibiotic prophylaxis prevents bacteremia-associated infective endocarditis that occurs after an invasive procedure. If antibiotic prophylaxis is effective, it should be given only to patients with the highest risk of adverse outcomes from infective endocarditis. Prophylaxis for dental procedures could be beneficial in patients with underlying high-risk cardiac conditions; however, the AHA recognizes that effectiveness of this therapy is unknown. […] The AHA recommends antibiotic prophylaxis for dental procedures in these patients during the first six months after the procedure. The AHA does not recommend prophylaxis after six months following a dental procedure if there is no residual defect.

• #30 Infective Endocarditis in Bicuspid Aortic Valve or Mitral Valve Prolapse Patients

  https://www.acc.org/latest-in-cardiology/journal-scans/2018/06/11/15/42/infective-endocarditis-in-patients-with-bicuspid-aortic-valve-or-mvp

  BAV and MVP patients had a higher incidence of viridans group streptococci IE than did the high-risk and low/moderate-risk group patients (35.2% and 39.3% vs. 12.1% and 15.0%, respectively; all p […] Compared to other patients with IE, IE among patients with BAV and MVP more often was associated with viridans group streptococci and IE from suspected odontologic origin, and complications were similar to those among high-risk IE patients. The authors concluded that these findings suggest that BAV and MVP should be classified as high-risk IE conditions, and the use of IE antibiotic prophylaxis should be reconsidered. […] Current guidelines recommend the use of antibiotic prophylaxis to reduce the risk of IE only among patients thought to be at especially high risk of adverse outcomes associated with IE, and notably do not include patients with known BAV or MVP. However, debate regarding the guideline recommendations continues. Supporting a more restrictive use of IE prophylaxis are data suggesting that, even if overall rates of IE are increasing, culprit microorganisms often are Staphylococcal species that would not be affected by typical antibiotic prophylaxis regimens. However, data from this large multicenter registry suggest that, among patients with known native heart valve diseases of BAV or MVP, viridans group streptococci (which would be affected by antibiotic prophylaxis) play an important role. Further, this study offers data suggesting that patients with BAV or MVP are at high risk of adverse clinical outcomes. In the absence of prospective randomized data, there remains a rationale to discuss antibiotic prophylaxis for IE risk reduction with patients with significant native heart valve disease, including BAV or MVP.

• #31 AHA Releases Updated Guidelines on the Prevention of Infective Endocarditis | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0215/p538.html

  Antibiotic prophylaxis is not recommended to prevent infective endocarditis in patients undergoing GI or GU tract procedures (e.g., diagnostic esophagogastroduodenoscopy, colonoscopy). […] A summary of the major changes in these updated recommendations for prevention of infective endocarditis compared with previous AHA guidelines is shown in Table 3.

• #32

  https://www.who.int/news-room/fact-sheets/detail/rheumatic-heart-disease

  Rheumatic heart disease can be prevented by preventing streptococcal infections through addressing poverty and improving living and housing standards, or prompt treatment of streptococcal infections with antibiotics when they do occur. […] Since rheumatic heart disease results from rheumatic fever, an important strategy is to prevent rheumatic fever from occurring. Treatment of strep throat with appropriate antibiotics will prevent rheumatic fever. […] Once a patient has been identified as having had rheumatic fever, it is important to prevent additional streptococcal infections as this could cause a further episode of rheumatic fever and additional damage to the heart valves. The strategy to prevent additional streptococcal infection is to treat the patient with antibiotics over a long period of time.

• #33 Prevention of aortic valve disease: between doubts and certainties

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-18/prevention-of-aortic-valve-disease-between-doubts-and-certainties

  Aortic valve disease and its prevention is a topic in constant evolution. Currently, medical therapy able to prevent the development of aortic valve disease is not available. […] Prevention also includes avoidance of rheumatic fever and endocarditis. […] Possible prevention strategies have been analysed in the literature. […] Medical therapy, cardiovascular risk factors and prevention of pathologies, such as rheumatic fever and endocarditis, are the most interesting fields which have been investigated in terms of prevention. […] Prevention of rheumatic heart disease means the prevention of the first attack of acute rheumatic fever. […] The objective of primary prevention is the proper identification and adequate antibiotic treatment of group A beta-haemolytic streptococcal tonsillopharyngitis. […] Prevention measures are based on good daily dental hygiene, using optimal quality toothbrushes, and dental follow-up. […] Prophylaxis for rheumatic fever and endocarditis must be performed according to the current indication to avoid the risk of consequent valvular diseases.

• #34 Frontiers | Improvement of Rheumatic Valvular Heart Disease in Patients Undergoing Prolonged Antibiotic Prophylaxis

  https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.676098/full

  Secondary prophylaxis of rheumatic heart diseases is efficient in reducing disease recurrence, heart damage, and cardiac impairment. […] Benzathine penicillin-based prophylaxis, every 3–4 weeks, remains the treatment of choice since GAS continues to be fully susceptible to penicillin. […] Secondary prophylaxis of RHD is known for modifying the natural history of the disease, allowing for the prevention of disease recurrence and consequently the prevention of further development of heart damage and/or cardiac impairment. […] Active patient recruitment in the reference center and early detection of oropharyngeal GAS were important factors for optimal adherence to the prophylactic treatment. […] No patients undergoing regular prophylaxis presented progression of the rheumatic cardiac disease.

• #35

  https://www.who.int/news-room/fact-sheets/detail/rheumatic-heart-disease

  For countries where rheumatic heart disease is endemic, the main strategies for prevention, control and elimination include improving standards of living; expanding access to screening and appropriate care for people with suspected or confirmed streptococcal infections and RF/RHD and treatment of RHD complications with medications; ensuring a consistent supply of quality-assured antibiotics for primary and secondary prevention; and planning, developing and implementing feasible programmes for prevention and control of rheumatic heart disease, supported by adequate monitoring and surveillance, as an integrated component of national health systems responses.

• #36 Frontiers | Improvement of Rheumatic Valvular Heart Disease in Patients Undergoing Prolonged Antibiotic Prophylaxis

  https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.676098/full

  This study confirmed that tailored and active efforts invested in rheumatic heart disease secondary prevention allowed for significant clinical improvement. […] None of the patients undergoing regular prophylactic treatment presented recurrence of ARF episodes or progression of the heart disease. […] Adherence to secondary prophylaxis also resulted in cardiac recovery in a significant number of patients, including some discharged with no echocardiographic abnormalities. […] Our results from Brazil shows that dedicated efforts for secondary prevention of ARF and RHD allow for significant clinical improvement.

• #37 Antithrombotic Therapy in Patients With Valvular Heart Disease

  https://www.uspharmacist.com/article/antithrombotic-therapy-in-patients-with-valvular-heart-disease

  Valvular heart disease (VHD) is a disorder in which a heart valve is damaged or diseased, resulting in poor cardiac blood flow. […] Most patients with VHD require surgery to repair or replace the valve and subsequent antithrombotic therapy to prevent clotting. […] After a prosthetic valve replacement, optimal antithrombotic therapy is recommended to prevent thromboembolism while minimizing the risk of bleeding. […] The therapeutic goals for treating VHD include reducing symptoms, repairing or replacing valves, and preventing blood clots. […] After the procedure, it is recommended that patients be started on antithrombotic therapy, such as warfarin or aspirin, to prevent thromboembolism. […] Patients with prosthetic valves are at high risk of clotting, so continuation of antithrombotic therapy may be recommended even in patients undergoing surgical procedures.

• #38 2020 ACC/AHA Heart Valve Disease Guideline: Key Perspectives, Part 3

  https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2020/12/16/22/01/2020-ACC-AHA-VHD-GL-Pt-3-GL-VHD

  The 2020 guideline for the management of patients with valvular heart disease replaces the American Heart Association/American College of Cardiology (AHA/ACC) 2014 guideline and the 2017 focused update. […] Management of mixed valve disease should follow the guidelines for the predominant lesion. […] Following an initial post-procedure transthoracic echocardiogram (TTE), surveillance imaging is recommended at 5 and 10 years, then annually. […] Antithrombotic therapy for prosthetic valves: […] Mechanical valves: Anticoagulation with vitamin K antagonists (VKAs) is recommended to achieve varying international normalized ratios (INRs) dependent on valve characteristics and patient risk factors (all Class 1). […] For high surgical risk patients with prosthetic valve dysfunction (stenosis or valve regurgitation), a transcatheter valve-in-valve procedure is reasonable at a Comprehensive Valve Center (Class 2a).

• #39 Antithrombotic Therapy in Patients With Valvular Heart Disease

  https://www.uspharmacist.com/article/antithrombotic-therapy-in-patients-with-valvular-heart-disease

  For minor procedures, including dental extractions or cataract removal, continuing warfarin to reach a therapeutic INR is recommended for patients with mechanical heart valves. […] Antithrombotic therapy recommendations for pregnant patients differ from those of nonpregnant patients. […] Pharmacists have the opportunity to play a key role in the management and monitoring of antithrombotic therapy for patients with VHD.

• #40 2020 ACC/AHA Heart Valve Disease Guideline: Key Perspectives, Part 3

  https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2020/12/16/22/01/2020-ACC-AHA-VHD-GL-Pt-3-GL-VHD

  Patients with IE should be managed by a multispecialty Heart Valve Team including an infectious disease specialist, as well as a neurologist for those who have had neurologic events. […] Women with severe valve disease (Stages C and D) considering pregnancy should undergo pre pregnancy counseling and appropriate testing by a cardiologist with expertise in managing valvular heart disease in pregnancy with subsequent monitoring at a tertiary care center with a dedicated Heart Valve Team (Class 1). […] In asymptomatic women considering pregnancy with either severe rheumatic mitral stenosis (MS) (mitral valve area 1.5 cm2, Stage C1) or severe aortic stenosis (aortic velocity 4.0 m/s or mean pressure gradient 40 mm Hg), valve intervention prior to conception is reasonable. […] Ideally, a switch to low molecular weight heparin (LMWH) (with target anti-Xa level of 0.8-1.2 U/ml 4-6 hours after dose) or IV unfractionated heparin (UFH) (with activated partial thromboplastin time [aPTT] 2x control) is made 1 week before planned delivery, followed by a switch to UFH 36 hours before planned delivery.

• #41 Heart Valve Disease: Treatment and Types | Froedtert & MCW

  https://www.froedtert.com/heart-valve-disease

  Heart valve disease is sometimes referred to as structural heart disease, as valve disease can impact the structure and function of your heart. […] Generally, those living with a heart valve condition should aim to reduce their overall risk factors for heart disease, including controlling blood pressure, not smoking and exercising regularly. […] Our heart valve disease experts treat the full range of structural heart conditions. […] We emphasize patient education and want patients to participate in their treatment decisions.

• #42 Patient-centered Treatment for Heart Valve Disease.

  https://www.medstarhealth.org/blog/valvular-heart-disease

  When it comes to keeping a healthy heart, most of us know what we should do: […] Talk with your primary care provider if you experience symptoms of heart valve disease. Your doctor, physician assistant, or nurse practitioner can help you navigate the care system, determine your next best steps, and provide you with verified information you can use to make good decisions.

• #43 Valvular Heart Disease | Heart and Vascular

  https://health.ucdavis.edu/conditions/heart-vascular/valvular-heart-disease

  You and your physician will discuss ways that you can lower your risk of developing heart valve disease as an adult. […] These may include steps such as: […] Increasing your physical activity […] Eating a healthy diet […] Following your physicians instructions when treating an infection.

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