Preventive Steps:
(1) Evaluate the patient's risk for infective endocarditis and inform the patient of this risk.
(2) Provide instructions for antibiotic prophylaxis and follow up to see that they are adhered to.
The highest risk of infective endocarditis or adverse outcomes is seen in patient with:
(1) prosthetic cardiac valves
(2) cardiac valves repaired with prosthetic materials
(3) history of infective endocarditis
(4) unrepaired cyanotic congenital heart disease
(5) palliated cyanotic congenital heart disease
(6) congenital heart disease completely repaired that includes prosthetic material
(7) congenital heart disease with residual defect and prosthetic material
Diagnostic Steps:
(1) Draw blood cultures prior to antibiotic therapy if the patient has an unexplained febrile illness, thromboembolic phenomenon or other finding that may indicate infective endocarditis.
(2) Perform appropriate imaging studies to visualize endocarditis:
(2a) transthoracic echocardiography for native valve endocarditis
(2b) transesophageal echocardiography: for prosthetic valve, prosthetic material-related, surgically corrected shunt, complex defects
(3) Perform appropriate imaging studies to document complications (thromboembolic, etc)
Management Steps:
(1) Early consultation with a surgeon who specializes in congenital heart disease so that emergency surgery can be performed in the event of a sudden deterioration.
(2) Early and aggressive antibiotic therapy with appropriate antibiotics selected based on sensitivity testing (if possible).
