0071643192.pdf

TABLE 2.17. Antibiotic Recommendation for Endocarditis Prophylaxis

Prophylaxis for Dental, Oral, Respiratory, and Esophageal Procedures

Standard Amoxicillin

Penicillin allergy Clindamycin

or

Cephalexin

or

Azithromycin

Prophylaxis for Genitourinary and Gastrointestinal (Nonesophageal)

Procedures

Moderate-risk patients Amoxicillin PO

Moderate-risk patients allergic to penicillin Vancomycin IV

High-risk patients Ampicillin +gentamicin IV

High-risk patients allergic to penicillin Vancomycin +gentamicin IV

■ Hypertrophic cardiomyopathy
■ Acquired valvular heart disease
■ Mitral valve prolapse with murmur

Recommended antibiotics for prophylaxis are listed in Table 2.17. An equiva-
lent intravenous antibiotic should be chosen for patients unable to take the oral
recommendations. No prophylaxis is needed for clean procedures (laceration
repairs, Foley catheter placement, intubation).

A 45-year-old male presents to the ED with chest pain and severe shortness

of breath. Clinically and radiographically, there is evidence of pulmonary

edema. He reports a history of IDU and “angina.” On cardiac auscultation,

there is a loud holosystolic murmur heard throughout the lower precordium with

radiation to the apex. The murmur does not change intensity with inspiration or

with passive leg elevation. This presentation and murmur is most consistent with

what valvular lesion?

This patient is presenting with acute mitral regurgitation. The likely causes in-

clude infective endocarditis or acute coronary syndrome, which may be differenti-

ated by ECG. In either case the treatment is aggressive afterload reduction with

nitroprusside, dobutamine (if hypotensive), and immediate valve replacement.

VALVULAR EMERGENCIES

The most common congenitalvalvular lesion is a bicuspid aortic valve.

The most common acquiredvalvular lesion is secondary to rheumatic heart
disease.

Table 2.18 summarizes the causes and exam findings for common valvular lesions.

CARDIOVASCULAR EMERGENCIES