Chapter 02: Infective Endocarditis
Little: Dental Management of the Medically Compromised Patient, 9th Edition
1. Which of the following is true concerning infective endocarditis (IE)?
a. IE is always due to a bacterial infection.
b. Since the advent of antibiotics, morbidity and mortality associated with IE have
been virtually eliminated.
c. IE is currently classified as acute or subacute, to reflect the rapidity of onset and
d. Accumulating evidence questions the validity of antibiotic prophylaxis in an
attempt to prevent IE prior to certain invasive dental procedures.
Antibiotics have been administered before certain invasive dental procedures in an attempt to
prevent infection. Of note, however, the effectiveness of such prophylaxis in humans has
never been substantiated, and accumulating evidence more and more questions the validity of
2. Which of the following is currently the most common underlying condition predisposing to
infective endocarditis (IE)?
a. Aortic valve disease
b. Rheumatic heart disease (RHD)
c. Mitral valve prolapse (MVP)
d. Tetralogy of Fallot
Mitral valve prolapse, which accounts for 25% to 30% of adult cases of native valve
endocarditis (NVE), is now the most common underlying condition among patients who
acquire IE. Previously, rheumatic heart disease (RHD) was the most common condition
predisposing to endocarditis. In developed countries, however, the frequency of RHD has
markedly declined over the past several decades.
3. The leading cause of death due to infective endocarditis (IE) is __________.
a. chronic obstructive pulmonary disease
b. heart failure
c. pulmonary emboli
The most common complication of IE, and the leading cause of death, is heart failure, which
results from severe valvular dysfunction. This pathologic process most commonly begins as a
problem with aortic valve involvement, followed by mitral and then tricuspid valve infection.
Embolization of vegetation fragments often leads to further complications, such as stroke.
Myocardial infarction can occur as the result of embolism of the coronary arteries, and distal
emboli can produce peripheral metastatic abscesses.