GeneralEndocarditis, an inflammatory disease of the inner lining of the heart may be one of the manifestations of rheumatic fever, and there may be a distinct disease of an infectious nature. Now we look at the reasons and the main symptoms of infective endocarditis (IE), as well as methods of diagnosis and treatment.
The etiology and route of infectionThe agents of endocarditis are often micro-organisms such as streptococci, staphylococci, enterococci, but the cause of the disease may be part of the normal microflora of the oropharynx, upper respiratory tract, as well as mushrooms. Infection can enter the body, such as surgery (for prosthetic valves Lab large vessels and even extraction of the tooth). Fairly high probability of IE in patients with weakened immune systems and the presence of foci of chronic infection (chronic tonsillitis, boils). Endocarditis is often formed on the background of an existing heart disease, so the risk group are also patients with congenital and acquired heart disease.
From the entrance gate of infection pathogen enters the bloodstream into the cavity of the heart, is deposited on the valves and valve forms of vegetation (growths). Surface valves with ulcerated and deformed. Most often damaged aortic and mitral valves, rarely tricuspid and pulmonary. Here are deposited platelets and fibrin strands that are responsible for the formation of blood clots. Once the leaflets are deformed so that they can not fully interlock, valvular formed, which in turn can lead to heart failure.
Microbial vegetation are also of great danger, and yet because of their elements can break away from the endocardial and spread through the bloodstream throughout the body, infecting other organs and tissues and causing blockage (embolism) of large vessels. That's why endocarditis disturbed blood supply to the kidneys, spleen, lungs, brain and the heart.
The disease may be acute or subacute. The cause of acute IE are likely to be self-hemolytic streptococcus, staphylococcus aureus, Streptococcus pneumonia. Subacute IE occurs more easily found in immunodeficient state and cause, for example, Streptococcus viridans, the normal flora of respiratory tract, oropharynx.
SymptomsIE starts with raising the temperature to 39 - 40 degrees and other non-specific symptoms (severe chills, excessive sweating, weight loss, muscle and joint pain). The skin and mucous membranes become pale jaundiced hue. Due to the fact that bacteria circulate throughout the body, including the smallest vessels, skin rash can appear small and small nodules characteristic dark-red color of the palms and soles of the feet (Osler nodes). Nail phalanxes of fingers and toes may become thicker with the development of the so-called symptoms of drumsticks themselves as nails thicken and become sort of "time windows". The main symptom of IE are a heart murmur, audible at auscultation phonendoscope. Heart murmur indicates malfunction of the valve and, depending on the degree of violation of his work may have a different tone, and volume.
DiagnosticsExamination of suspected IE includes a detailed examination of the patient, and especially careful cardiac auscultation, various blood tests, ECG, cardiac ultrasound (echocardiography). In the overall analysis of blood revealed the typical signs of inflammation (increased erythrocyte sedimentation rate, leukocytosis). It is also necessary to sow twice venous blood in order to identify the specific pathogen (this requires two samples of blood). Negative blood cultures, however, does not exclude the diagnosis of IE. The decisive role played by echocardiography in the diagnosis (through the anterior chest wall or transesophageal), with which you can reliably establish the presence of microbial vegetation, the degree of valvular and violations of the pumping function of the heart.
What can a doctor?If the diagnosis of IE is confirmed, the doctor will prescribe antibiotic therapy, taking into account the results of blood cultures. Generally, a broad spectrum antibiotics (penicillins, cephalosporins), in relatively large doses. If the causative agent of the disease is aggressive c ivnye bacteria, such as Staphylococcus aureus, in addition appoint another narrow-spectrum antibiotic (vancomycin, aminoglycosides). Fungal endocarditis is extremely difficult to treat. In rare cases (with the ineffectiveness of antibiotics, irreversible damage heart valves, the development of severe heart failure) should be surgical excision of microbial vegetation.
Patients at risk necessarily receive antibiotic prophylaxis after any invasive procedure or surgery (tonsillectomy, adenectomy, tooth extraction, any endoscopic manipulation, abortion, bladder catheterization, etc.).