Endocarditis is an inflammation of the endocardium, the inner lining of our heart. It can cause pathologies in many organs and systems of the human body, trauma, hypercoagulation and other non-infectious causes. Therefore, endocarditis in itself is only their symptom, in the presence of which Roth spots, Osler nodules and other characteristic rashes on the body do not appear. Patients may not feel discomfort at all, and in rare cases complain of heart murmurs, fever. And only if microorganisms parasitizing in the blood have caused inflammation of the endocardium, it becomes an independent disease and is called infectious, bacteriological or septic endocarditis. Osler's nodules are one of his outward signs. They were described in 1885 by the wonderful Canadian therapist William Osler. Infectious endocarditis is a very dangerous disease, leading to irreversible deformations in the heart, so it is vital to know what it is and how it manifests itself.
Features of infectious endocarditis
This disease is caused by almost all pathogenic bacteria and fungi, and sometimes even viruses and protozoa in the bloodstream of humans. They can invade the endocardium with infectious diseases of the respiratory system, rheumatism, periodontitis, tonsillitis, tuberculosis, with catheterization of the urethra, tooth extraction and other manipulations. Osler's nodules are a clear signal that the underlying disease has caused a complication - infectious endocarditis. In the vast majority of cases, for the onset of parasitic activity of microorganisms, there must be some damage in the heart:
- venous catheters;
- pacemakers;
- prostheses of blood vessels or heart valves;
- various heart defects;
- microtrauma;
- surgical intervention.
Sometimes bacteria enter the endocardium without previous tissue damage. Then abscesses, fistulas and other defects form.
Symptoms
Infectious endocarditis can express itself clearly and distinctly, and at first it can only be bothered by fatigue, heart murmurs, general weakness, and more formidable symptoms gradually increase. These include:
fever;
- chills;
- profuse sweat;
- sore muscles and joints;
- weight loss;
- discoloration of the skin (becomes grayish, slightly yellowish);
- rash on the mucous membranes.
Osler's nodules appear after the above symptoms. Some experts consider them a characteristic and mandatory sign of infectious endocarditis, while others, on the contrary, its relatively rare manifestation, in which the disease passes in a subacute form.
Osler nodules, pathogenesis
These formations appear on the palms, fingertips, feet due to inflammation of the walls of small blood vessels caused by the infection and represent an infiltrate. Histological examination of the nodules reveals dilated venules and arterioles. Sometimes they are confused with an allergic rash or septic purpura. Osler's nodules look like, the photo shows quite clearly. These are convex, pea-sized or slightly smaller motile formations of a red or purple hue, sometimes painful, sometimes not. They develop quickly, disappear on their own, are not a separate disease, therefore, treatment with tablets or ointments is not required. But if a person noticed such nodules in himself, he should immediately consult a doctor for additional laboratory and clinical studies.
Rota Spots
In addition to Osler’s nodules, infectious endocarditis can cause a rash of hemorrhagic nature on the sides and extremities, hemorrhages under the nail plates, Jeanetier spots, which also occur like Osler’s nodules on the palms and soles of the feet. But, unlike nodules, these spots are completely painless, not like peas and are the result of a rush of blood to the capillaries.
In infectious endocarditis, in addition to the skin, eyes can be affected. One of the common signs of such a reaction to inflammation are Roth spots. The Swiss doctor Roth described them. Roth spots are microbleeds in the retina. In shape they are oval or round with a white dot in the middle. In patients, these formations can cause a decrease in vision, which is restored after treatment of the underlying disease.
Roth spots are a symptom of not only infectious endocarditis, but also anemia, collagenosis. Therefore, to make a diagnosis, additional studies are needed.
Other symptoms of infectious endocarditis
There are about a dozen symptoms that make it possible to suspect endocardial inflammation due to infection.
Osler's nodules, Lukin's spots (or the Lukin-Liebman symptom correctly), the symptoms of Rock, Dmitrienko, Dzheynuey and others help doctors make a diagnosis, especially in cases where other characteristic signs of the disease are not clearly expressed or absent.
The symptom of Lukin-Libman is the appearance of point petechiae with a whitish center on the folds of the eyelids and conjunctiva.
The symptom of Rock is manifested in the expansion of the pupil of the left eye.
The symptom of Janeway is erythematous formations, like Roth spots, protruding on the palms and feet, only in this case they are small in size.
The symptom of Dmitrienko is to soften the tone of the 1st tone, which is why it is also called the "velvet tone". This symptom is observed at the very first stages of the disease.
Treatment
Only a physician can determine the cause of any specific symptom. As a rule, this requires laboratory tests of blood, ECG, echocardiography. Blood sowing is mandatory to identify the causative agent of the infection. If the tests showed the patient has infectious endocarditis, antibiotics of the corresponding group are prescribed. In severe cases, surgery is performed (plastic surgery, heart valve prosthetics).
With the timely diagnosis and timely treatment started, 50-90% of patients live more than 5 years. In order to prevent the occurrence of infectious endocarditis, a special technique has been developed for people at risk. It has several modes of prevention based on the use of medicines in the situations noted by the technique.