GP emergency management

Is this a case of subacute bacterial endocarditis?

Vivienne Miller



George is well known to you and lives with his eldest daughter. He is 86 years old and has had type 2 diabetes for 12 years controlled by long-acting metformin 1000 mg daily. He has had mitral valve regurgitation of moderate severity diagnosed at age 81 years. This has not progressed over the past five years and is being managed conservatively. He also had an uncomplicated myocardial infarction at age 77 years. He has hypertension controlled with candesartan 8 mg daily. He is also taking simvastatin, 40 mg daily, aspirin 100 mg daily and vitamin D 3000 IU daily. He has good renal function for his age.

Key Points

  • If subacute endocarditis is suspected, at least three blood cultures should be arranged urgently.
  • The most common bacteria responsible for subacute endocarditis are Streptococcus viridans and Enterococcus species.
  • From a cardiac point of view, people with prosthetic valves or rheumatic heart disease are at highest risk of subacute bacterial endocarditis, as are those who have had it before.
  • Good dental hygiene and regular dental reviews are vital in the prevention of endocarditis.