ENDOCARDITIS

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Endocarditis - an inflammation of the endocardium. When localized on the valves of the heart valves (valvulitis) is the basis for the formation of most acquired heart defects. Like myocarditis , with which it usually combines, endocarditis refers to the leading manifestations of heart damage in rheumatism and other diffuse diseases of connective tissue. Endocarditis of other origin is divided into infectious and non-infectious; The latter include allergic endocarditis, fibroplastic parietal endocarditis with eosinophilia, as well as aseptic endocarditis in cardiac trauma (including postoperative), intoxications (for example, with uremia), myocardial infarction, when the occurrence of endocarditis is associated with the formation of parietal thrombi in the heart cavities Thromboendocarditis). Infective endocarditis occurs when bacteria, viruses, fungi are introduced into the endocardium; Sometimes it is a manifestation of a specific heart attack in tuberculosis, syphilis, brucellosis. Independent clinical significance is nonspecific infective endocarditis, which is divided into acute and subacute by variants of the course.

Acute infective endocarditis lasts up to six weeks from the appearance of the first symptoms of the disease and is essentially one of the manifestations of sepsis, coinciding with it in etiology; In a number of patients it is possible to detect the entrance gates of infectious agents. The most common causes of endocarditis are purulent otitis , inflammatory diseases of the paranasal sinuses (sinusitis), cystitis , urethritis , salpingoophoritis , etc. The development of endocarditis is associated with bacteremia, the settling of microorganisms on the valves of the heart, where the inflammatory process predominantly localizes. Depending on the location of the entrance gates and the primary infectious focus, the valves of either the right heart are damaged (the tricuspid valve or pulmonary trunk valve develops) or (more often) the left one, the aortic valve failure occurs.

The clinical picture at the onset of the disease is mainly manifested by signs of sepsis. Characterized by a high fever with chills and sweating; Severe intoxication with headache, inhibition, enlargement of the liver and spleen, hemorrhages on the skin, mucous membranes, on the fundus, the formation of small painful nodules on the palmar surface of the fingers. There are bacterial embolisms in various organs with the formation of purulent metastatic foci. Laboratory reveals anemia, leukocytosis , increased ESR. The first signs of heart failure are tachycardia and muffling of cardiac tones. In fact, endocarditis is indicated by a change in the existing heart sounds or the sudden emergence of new ones due to valvulitis, perforation of the valve flap or rupture of the tendon thread. Localization and the nature of noise can determine the appearance of the emerging heart defect. With a significant violation of intracardiac hemodynamics, symptoms of rapidly increasing heart failure appear.

Subacute bacterial endocarditis (prolonged septic endocarditis) often develops on the background of a previously acquired or congenital heart disease, less intact valves are affected. The basis of the disease is subacute sepsis , in most cases caused by staphylococcus or streptococcus, an important role in the pathogenesis of the disease is played by disorders of the body's immune state.

The clinical picture consists of the symptoms of the infectious process, immune disorders and signs of damage to the heart valves. There are fevers of the wrong type with tremendous chills, profuse sweating; Signs of intoxication - pain in the joints and muscles, muscle weakness; As a rule, noticeable weight loss is developing rapidly. Often, patients have a peculiar coloration of the skin (the color of coffee with milk); Petechial rashes on the skin (up to a common hemorrhagic rash) and conjunctiva, painful subcutaneous nodules near the fingertips (Osler's nodules), changes in nails in the form of watch glasses and end phalanges like drumsticks are detected (see Drum fingers). Often when palpation is determined enlarged spleen, less often - the liver. In the blood, anemia is detected, often leukocytopenia (sometimes leukocytosis), an increase in ESR. In the urine, as a rule, identify microhematuria and microproteinuria. Sometimes the picture of the disease is erased - many of the listed symptoms are absent. In the first weeks, and sometimes in the first 2 months of the disease, changes in the valvular heart apparatus may not be clinically determined. Subsequently, symptoms of heart disease (usually aortic insufficiency, usually associated with perforation of the valve of the aorta valve, and occasionally - mitral insufficiency) appear or the auscultatory pattern of the already existing defect changes. Often there are vasculitides, various thromboembolic complications. Sometimes the cause of emergency hospitalization of the patient is a heart attack of the kidney, spleen or lung; It is also possible to develop a myocardial infarction or hemorrhagic stroke.

Treatment of endocarditis consists in the therapy of the underlying disease, for example rheumatism, systemic lupus erythematosus, sepsis, etc. In infectious endocarditis, the leading place is taken by active antibiotic therapy, which should be started as soon as possible and coordinated with the results of blood cultures on the flora and the sensitivity of microbes to antibiotics. In subacute septic endocarditis, high doses of the sodium salt of benzylpenicillin (up to 60 to 80 million units per day) or semi-synthetic penicillins (oxacillin, methicillin, etc.) or cephalosporins intravenously and / or intramuscularly in combination with gentamycin are used from the very beginning. If the disease is caused by staphylococcus, semi-synthetic penicillins resistant to penicillinase have an advantage. With intolerance to penicillins, vancomycin is indicated . Effective replacement of the damaged valve. Depending on the complications of septic endocarditis (thromboembolism, heart failure , etc.), other means are used. The main task of the average medical personnel is to closely monitor and care for the patient, strict performance of medical appointments.

The prognosis is serious. Timely antibiotic therapy allows for the majority of patients to achieve remission (sometimes for 3-5 years), but also during this period the patients remain, as a rule, incapacitated. Recurrences of infective endocarditis lead to severe damage to the valvular heart apparatus and progressive heart failure. Some patients die from acceding chronic renal failure.

Prevention of infectious endocarditis is reduced to preventing septic complications, especially in patients with congenital or acquired heart defects. If there are foci of chronic infection, they must be sanitized.