Cardiac Patients

Antibiotic pre-medication is required for cardiac conditions associated with high risk for developing infective endocarditis. There are five conditions associated with adverse outcomes for which prophylaxis for dental treatment is indicated:

Prosthetic heart valve, which includes transcatheter-implanted prostheses and homografts.
Prosthetic material used for cardiac valve repair, such as annuloplasty rings and chords.
Previous history of infective endocarditis.
Cardiac transplant with valve regurgitation due to a structurally abnormal valve.
Congenital heart disease (CHD), or conditions which have been present since. Specifically, the following two CHD’s are a concern:
1. Unrepaired cyanotic CHD, including palliative shunts and conduits
2. Repaired CHD defect with residual shunts or valvular regurgitation at the site of, or adjacent to the site of, a prosthetic patch or a prosthetic device (Figure 2).^8,9

Table 2 provides questions that are helpful for oral health practitioners to ask when reviewing the medical history of patients suspected of having high risk cardiac conditions.

Table 2. Follow-Up Questions for High Risk Cardiac Patients⁽¹⁾
Do you have an artificial heart valve? Do you have a history of infective endocarditis? Do you have a heart transplant? If yes, how long ago? Do you have any heart valve damage? Do you have congenital heart disease? If so what type? How has it been treated? Has your cardiologist told you to take antibiotics prior to having dental work?

In summary, premedication is most often indicated in situations involving severe valvular conditions. These premedication requirements are standard protocol per the ADA and American Heart Association (AHA) and do not require a medical consult. However, congenital heart conditions will often times require a consult with the medical provider to determine specific antibiotic prophylactic needs.

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