From: dyer@spdcc.com (Steve Dyer)
Newsgroups: sci.med
Subject: Re: mitral valve prolapse and need for antibiotics?
Date: 28 Sep 92 22:18:44 GMT
Distribution: sci
Organization: S.P. Dyer Computer Consulting, Cambridge MA

In article <BONNIE.92Sep28130237@aigyptos.nmsu.edu> bonnie@nmsu.edu (Bonnie Hargrave) writes:
>The echo test tells my family practitioner that I have a mitral valve
>prolapse.  This doctor nows recommends to me that, before I have any
>invasive medical procedures done -- including having my TEETH CLEANED
>-- that I should take penicillin, both before and after the procedure.

I'm not a doctor, so I'll let them comment on current practice.
However, I happen to have two acquaintances walking around and ticking
with prosthetic heart valves because of the consequences of such
seemingly innocuous dental procedures.  And these guys weren't
waif-like, nervous women diagnosed with asymptomatic mitral valve
prolapse.  One of them was a competitive bodybuilder.  It's a crime to
see him now.  It's also a crime to reflect on the fact that his HMO
didn't diagnose his symptoms early enough and actually turned him away
once as a malingerer; he had to be carried unconscious into an
emergency room.  It's even scarier, reflecting on the fact that this
happened in the HMO I go to.  (He hadn't been previously diagnosed with
any murmurs, and he didn't fit the typical profile of such individuals.
I don't know if his recent dental work had come out in the history.)

Anyway, there are a variety of surgical procedures, including simple
tooth cleaning, which can cause a transient bacteremia (bacteria in the
circulating blood).  In the case of dental work, these are ordinarily
non-pathogenic streptococci which are part of the normal flora in your
mouth.  But they don't usually belong in your blood, and in some individuals
with otherwise harmless valve dysfunctions, the circulatory eddies can
cause these bacteria to adhere to small clots on the surface of the valve
and act as a focus for infection.  What follows can be the slow destruction
of a heart valve and, if untreated, heart failure.

>I think taking antibiotics, especially broad-spectrum type, without a
>very good reason is dangerous.

Reading too many of those "Yeast Blah-Blah" books, eh?  Here's a word of
advice: throw them out.  It's crap like that which makes otherwise rational
people mistrust perfectly legitimate and _important_ advise given to them
by reputable physicians.  First, many (not all) antibiotics are remarkably
non-toxic to the patient, and people take them without any side effects at
all.  In fact, I would wager that the biggest danger of most antibiotic
overuse is that when they're used indiscriminately and inappropriately,
it's the development of resistant organisms which post a danger to others
in the future.

It's likely that you'd be given penicillin, and the penicillin you'd likely
be given would be penicillin G or (more probably) penicillin V, since it's
better absorbed orally.  These are not broad-spectrum antibiotics.  In the
case of pencillin allergy, or some other clinical considerations, you might
be given erythromycin or maybe something else.  Anyway, the idea here is that
prophylaxis IS a very good reason to take such drugs if you have a condition
where such is indicated, and the potential consequences of NOT doing so could
very well lead to permanent impairment or death.

>She says the prolapse problem could
>result in bacteria reaching my heart during any procedure that results
>in internal bleeding -- INCLUDING bleeding gums.

Yup.

>What's the general medical thought about this, please?

Well, that was my two cents.  That's cheaper than a value replacement.

-- 
Steve Dyer
dyer@ursa-major.spdcc.com aka {ima,harvard,rayssd,linus,m2c}!spdcc!dyer
Newsgroups: sci.med