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Infective Endocarditis and IV Substance Use

For more information, visit: https://medicine.yale.edu/intmed/genm.... How To Stay Safe While Injecting Substances: There are a few key strategies to remember when you're injecting substances. First, make sure you wash your hands or use hand sanitizer before preparing your substance for injection. Second, make sure to thoroughly clean the area where you intend to inject with an alcohol swab or soap and water. Third, use a new needle for every injection. But if that is not possible, make sure to clean your needle and syringe with a solution of water and a little bit of bleach before injecting. Fourth, use a clean water source to mix your drugs, ideally sterile water in these packages that you can get at a syringe service program. Make sure that you use a sterile cooker. You can also get these at syringe service programs to mix your drugs and don't share a cooker or needles or syringes with others. Finally, avoid licking your needle or your skin before or after injection. Make sure to cover any open wounds. This is not an exhaustive list and we know this is sometimes not possible to always do these, but it can definitely help prevent serious infections like endocarditis. If you develop an abscess or another skin wound that won't heal, please seek medical advice. Thanks for utilizing all these harm reduction strategies to prevent infections like endocarditis. What is Infective Endocarditis? Infective endocarditis is an infection that involves the lining of the heart, most commonly affecting the heart valves. When bacteria travel through the bloodstream, they can settle on the heart valves and create pockets of infection called vegetation. Valves that are abnormal from birth, artificial or prosthetic valves, and those that have been damaged from prior infection or rheumatic fever are more likely to become infected. It is thought that repeated ongoing injection of substances can cause damage to the tricuspid valve, which is the first valve encountered as blood returns to the heart. At Risk Practices: Not cleaning skin prior to injection can allow bacteria on the skin to enter the bloodstream and grow freely. There are several ways that injecting drugs can lead to endocarditis. First, if the skin is not cleaned well prior to injection, the bacteria that are normally present on the skin surface can get into the bloodstream and grow freely. Unclean needles, often the result of reuse will allow for injection of bacteria into the bloodstream. The practice of licking needles prior to injection, coats the needle with bacteria from the mouth, which are then injected along with the drugs. These bacteria are common causes of endocarditis. The liquid used to dissolve drugs prior to injection may be contaminated with bacteria as well. Heart Changes After Getting Infective Endocarditis: When bacteria from injection get into the bloodstream, they can travel to the heart and attach to one of the four heart valves. When this happens, the bacteria can grow into an infectious mass called a vegetation. Small vegetation may not affect heart function at all, but larger vegetations can impair the ability of blood to flow through the heart, leading to heart failure or an inability of the heart to circulate blood properly throughout the body. Larger vegetations can also break off the heart valves and travel to other parts of the body, most dangerously, to the brain where they can cause strokes. Sometimes, endocarditis can also invade the tissue around the valves and interfere with the electrical conduction that prompts the heart to beat, which can require a pacemaker. Cardiologists use an ultrasound test called an echocardiogram to look for evidence of endocarditis and, if a vegetation is seen, we can measure its size and evaluate whether it is significantly affecting blood flow through the heart. What To Do If You Think You May Have Infective Endocarditis: If you are concerned, you may have infective endocarditis, you should seek immediate medical attention. Concerning symptoms of infective endocarditis include: fatigue, fever, difficulty catching your breath, chest pain, swelling in your limbs, and a rash on your fingertips or toes. Evaluation requires blood work and an ultrasound of the heart. If left untreated, infective endocarditis can cause worsening infection, serious disability or death. It is important to get treatment quickly. 0:06 How To Stay Safe While Injecting Substances 1:20 What is Infective Endocarditis? 2:03 At Risk Practices 2:40 Heart Changes After Getting Infective Endocarditis 3:43 What To Do If You Think You May Have Infective Endocarditis 4:20 How is Infective Endocarditis Treated? 4:57 Surgical Treatment of Infective Endocarditis 6:32 Treatments for Opioid Use Disorder 7:55 Specialized Care for Addiction at Yale New Haven Hospital