Require Risk Assessment for Infectious Endocarditis

I am a small animal veterinarian. I have recently been found to have a
systolic murmur(mitral) Grade 3/6 and a diastolic murmur (aortic) grade 1/4
as diagnosed by a cardiologist. Further diagnostic tests including an
echocardiogram are not scheduled until mid October.

I have been informed that I require prophylactic antibiotic therapy prior to
any dental procedures and for certain surgical procedures. My internet
searches have revealed that cellulitis may also be a potential source of
infective endocarditis. My physician has not yet been able to let me know if
an infection from a cat/dog bite could be a hazard. Bites are a daily risk
and a common occurrence. It is impossible to turn away patients because they
are aggressive - it is my job to help injured frightened animals.
Veterinarians,staff and owners often require antibiotic therapy or
hospitalization from animal bites.

We are also the animals' dentists and routinely use an ultrasonic scaler
which aerosilises oral bacteria. Gloves and masks are worn, but due to our
layout, we may be in and out of the treatment area for drugs or other
required materials during a dentistry. Can I practice safely? Help me solve
this dilemma please.

Dr. Cindy Rodgerson, DVM
Basinview Animal Hospital

[Cleveland Clinic, MD]

Dear Dr. Rodgerson,

Thank you for your question.  A murmur by itself is not an indication for antibiotic prophylaxsis.  There must be some other identified valvular abnormality such as mitral valve prolapse to recommend  antibiotics.  For the sake of arguement lets say that there is some abnormality detected on echo.  This shouldn't inhibit your practice in any way.  While it is true that any bacteremia increases the risk for endocarditis the risk is still very small for any given episode.  The trend in cardiology today is towards less antibiotics for less indications.  True, you would treat an infected animal bite but this would be treated regardless of valve status.  The aerolization of bacteria has never been shown to be a risk factor for endocarditis and there are many human dentists with valve problems.  So I don't see any drastic changes in your work ahead.  Be sure to follow-up with the echo.