Although cardiovascular disease is recognized as the number one health risk in many countries, many people still remain largely uninformed about its symptoms and causes. The focus tends to be on heart attacks, which results from a lack of blood flow to the heart tissue, but a number of other heart diseases are becoming more common.
Among them is infective endocarditis (IE), an infection of the endocardial surface of the heart that can seriously damage the heart valves. When one or more of the heart valves malfunctions, other serious complications such as stroke, heart failure, a need for open heart surgery, or even death may result. Infection occurs when bacteria enter the bloodstream and settle in the heart lining, a heart valve or a blood vessel. The infection most often occurs in people with pre-existing heart defects, as well as from those who have suffered rheumatic fever, skin inflammation, tonsillitis or pharyngitis. Dental treatment, such as the extraction of a tooth, as well as intravenous drug use, can also introduce the infection.
Dr. Chokchai Suwanakijboriharn, a specialist Cardiothoracic Surgeon with Bangkok Heart Hospital, explains that the infection can damage the heart valves resulting in the heart not being able to efficiently pump blood to the body. This may lead to a congestive heart failure or heart rhythm changes and causes symptoms such as headache, backache, shortness of breath, chest discomfort, fatigue, and prolonged fever. If patients do not receive prompt treatment, the outcome may be fatal.
But there is also good news. Take the case of Mr. Pragasit Deelert, the 50-year-old branch manager of the Bank for Agriculture and Agricultural Co-operatives (BAAC) in Mae Sot who was diagnosed with Infective Endocarditis. In January 2012, he visited his local hospital in Tak province complaining of chest discomfort and blood in his throat when he coughed. The doctor primarily diagnosed an infective valve endocarditis. Mr. Pragasit was reluctant to believe this diagnosis because he exercises regularly. However, as he also smoked and enjoyed alcohol, both risk factors for heart problems, he decided to follow the recommendation of his friend, who also suffers from cardiovascular disease, and go to the Bangkok Heart Hospital for further diagnosis and treatment. Two weeks later, he arrived at Bangkok Heart Hospital where he complained of difficulty in breathing. Medical workers put him on a breathing tube and gave him the medication to treat a heart attack. He was then referred for echocardiographic examination and the diagnosis confirmed that he was indeed suffering from infective mitral valve endocarditis.
Dr. Chokchai notes that Mr. Pragasit’s heart valves were severely damaged and that the damage could not be repaired. He suggested that the patient have open-heart surgery to replace the valve or, more exactly, the implantation of an artificial heart valve to replace the malfunctioning natural heart valve. There are two main types of artificial heart valves – bioprosthetic and mechanical. The bioprosthetic valve is made of biological material, such as the heart valves of a pig, cow or horse, which has gone through the correct processes. It is best used in young children, women of child-bearing age and people over 65 years of age, as there is no need for anticoagulant drugs in the long term after surgery. Despite its high cost, the durability of this type of valve is only 12-18 years.
In contrast, the modern mechanical valve is made of synthetic materials that can last indefinitely – more than 500 years. Mr. Pragasit opted for the mechanical valve because the heart valve replacement needed to be done only once.
Prior to surgery, Dr. Chokchai stresses that the IE patient must be informed of the whole treatment plan to that he can prepare himself mentally. To reduce the complications
as much as possible, the Bangkok Heart Hospital provides state-of-the-art medical equipment and a sophisticated medical team that includes the surgeon, anaesthetist,
physiotherapist and heart-lung machine operator along with the highest standard of hospital management system guaranteed by HA (Hospital Accreditation) and JCI (Joint Commission International). Thus, the surgery for mitral valve position has a very low risk, at 3-5%, while for aortic valve replacement, the risk factor is just 5-7 %.
Following the heart valves replacement procedure, only 5-7 days are needed for recovery in the hospital. The heart itself can recover within 6 weeks while the sternum or breastbone needs longer, about 3-6 months. During this period, the IE patient should avoid doing any strenuous activities or undergoing any dental treatment likely to cause bleeding. Driving is prohibited in order to avoid accidents due to breastbone pain while making a turn.
In taking care of his health, Mr. Pragasit is following the advice of his physiotherapist to the letter. He has given up smoking and alcohol, sleeps early, eats healthy foods and exercise by walking briskly for 30-45 minutes per day, everyday, and his health is much better than before. Dr. Chokchai explains that regular exercise at least 4 days per week is very important for IE patients, particularly aerobic exercise which includes walking, jogging, jumping rope and bicycling. It makes the heart work more efficiently and also improves breathing and blood circulation.
While Mr. Pragasit is good example of how appropriate treatment and aftercare can offer a high quality of life, the best cure is always prevention. If you experience any abnormalities such as skin abscesses, tonsillitis or prolonged fever lasting more than 3-4 weeks, it is best to consult a doctor, as one or more of these may be a warning sign of infective endocarditis.
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