The term "rheumatic endocarditis" refers to a pathological process characterized by inflammation of the inner lining of the heart. As a result, myocardial chambers become inelastic and lose their smoothness. The disease can occur due to many reasons. However, doctors believe that rheumatism is the main trigger factor for the development of the disease. At the same time, tendons, connective tissue of the valves and parietal endocardium are involved in the inflammatory process.
Pathogenesis
The disease is characterized by the formation of blood clots and an increase in the area of granulation tissue. With rheumatic endocarditis, lesions of the aortic and mitral valves are more often observed. Sometimes they are both involved in the pathological process. In isolated cases, a lesion of the tricuspid valve is detected.
The mechanism of the development of the disease is as follows:
- Under the influence of any adverse factor in the myocardium, the development of the inflammatory process starts. Then it spreads to nearby tissues through the fibrous ring.
- Collagen fibers swell in the valve, and proliferative inflammation develops. Against the background of this process, diffuse infiltrates are formed, that is, foci filled with cellular elements with an admixture of lymph and liquid connective tissue.
- The valve surface is undergoing changes. It forms fibrin and blood clots. Typically, this occurs in areas that are subject to mechanical damage. In most cases, we are talking about the closing zone of the valves. When the mitral valve is damaged, the focus of the pathology is formed on the side that faces directly to the atrial cavity.
- Outgrowths and scars form on the damaged tissue. Due to this, the valves are deformed.
The most common outcome of rheumatic endocarditis is heart disease. But this is not the most dangerous complication. In this regard, the doctor must be consulted when the first alarming signs occur.
Etiology
As mentioned above, doctors consider rheumatism the main reason for the development of pathology. At the same time, against the background of the course of the latter, the active vital activity of streptococcal infection is often detected in the patient's body. If the body is exposed to the negative effects of the pathogen for a long time, re-infection occurs. Due to this, the process of destruction of the connective tissue is launched, the permeability of blood vessels increases. In addition, there is a violation of the neurohumoral reaction.
Other causes of rheumatic endocarditis:
- Pathologies of connective tissue of a diffuse nature.
- Recently performed surgical intervention in the organs of the cardiovascular system, the outcome of which was unsuccessful. As a rule, rheumatic endocarditis in this case is the result of a medical error.
- Allergic reactions. Most often, the uncontrolled medication is a provoking factor.
- Intoxication process in the body.
- Bacterial diseases.
The most harmless reason, doctors consider intolerance to a particular drug. This is due to the fact that this form of the disease practically does not give complications. In the future, the patient only needs to avoid taking the medication, which is an allergen.
Types of disease
Doctors classify rheumatic endocarditis in several ways. There are 4 types of disease:
- Diffuse. In this case, the structure of the connective tissue changes on the entire surface of the valve. Often, small granulomas are found from the side of the left ventricle. Valve flaps significantly thicken, which is why the heart ceases to function normally. A diffuse type of pathology is characterized by simultaneous tissue damage in several areas at once. With timely treatment, the prognosis is usually favorable.
- Acute warty. In this case, the detachment of the upper layer of the endocardium occurs. Fibrin accumulates in the focus of the pathology and thrombotic masses are deposited. This, in turn, leads to the formation of warts, which in appearance have the appearance of tubercles of gray or light brown color. Often they unite and form large pathological foci. In this case, warts do not contain pathogens, but the likelihood of secondary infection is not excluded.
- Return warty. The changes are similar to those described above. The difference from acute warty endocarditis is only in the course of the pathology. With this type of disease, formations form periodically. At the stage of remission, it is almost impossible to identify them.
- Fibroplastic. Changes with this type of ailment are irreversible. In this regard, the doctor can recommend only surgery for patients with endocarditis.
Regardless of the type of disease, treatment of the disease cannot be delayed. This is due to the fact that changes in the heart pose a threat not only to health, but also to human life.
Clinical manifestations
Symptoms of rheumatic endocarditis are usually nonspecific. All forms of the disease have the same clinical manifestations. At the stage of the survey, the doctor can only find out the nature of the pathology (whether it is infectious or not).
Symptoms of rheumatic endocarditis:
- Dyspnea. At the initial stage of the development of the disease, it appears only after high-intensity physical exertion. Its duration is approximately 2 minutes. Over time, its intensity intensifies, it begins to disturb even at rest.
- Pain in the heart. With endocarditis, they do not always occur. But at a late stage, pain in any case appears against the background of physical exertion and prolonged exposure to stress.
- Heart palpitations. Tachycardia is characteristic of absolutely any form of ailment. Moreover, its occurrence is not associated either with physical exertion or with any other factors.
- The formation of drum fingers. This symptom appears in the late stages of the disease. The fingers become very narrow, and the last phalanx, on the contrary, expands greatly.
- Change the shape of the nails. Plates are becoming wider. Then they acquire a rounded shape. The central part of the nails rises, as if forming a dome.
- Pallor of the skin. It is characteristic for any stage of the disease. Against the background of serious damage to the valves, cyanosis of the fingers and the tip of the nose is often observed.
- Increased fatigue. Like shortness of breath, at the initial stage of development appears only after intense physical exertion. Over time, fatigue increases, the patient quickly becomes tired even after the usual daily activities.
The above clinical manifestations do not allow the doctor to accurately diagnose. He can only assume the presence of the disease and its nature. The following symptoms indicate an infectious pathology: chills, fever, excessive sweating, skin rashes, migraine, muscle soreness.
In children, rheumatic endocarditis manifests itself in the same way as in adults. Most often, the disease is detected during a routine examination with a pediatrician. A month after the onset of the development of the pathological process in the heart, you can hear noises.
Activity Stages
The nature of the disease directly affects the intensity of clinical manifestations. Doctors distinguish three stages of the activity of the pathological process:
- The minimum. It is characteristic of protracted rheumatic endocarditis. Symptoms are mild.
- Expressed. It is characteristic of constantly recurring endocarditis.
- The maximum. It is accompanied by extremely pronounced symptoms. At the same time, signs of damage to other body systems appear.
The difficulty lies in the fact that in the early stages of the disease rarely manifests itself. As a result, patients go to the doctor already at the stage of complications.
Diagnostics
When the first alarming symptoms appear, you must make an appointment with a cardiologist. The specialist will conduct an examination and history taking, after which he will draw up a referral for examination.
Necessary diagnostic measures:
- General and biochemical blood tests.
- Study on streptococcus antibody titers.
- Canned sample.
- ECG.
- X-ray examination.
Based on the diagnostic results, the doctor draws up the most effective treatment regimen.
Treatment
If rheumatic endocarditis is detected, the patient is hospitalized. He must be in the hospital for the entire period of treatment.
Initially, a test is carried out in the hospital for the sensitivity of the pathogen to antibiotics. The need for the test is due to the fact that the main stage of treatment for rheumatic endocarditis is antibiotic therapy. In most cases, doctors prescribe Penicillin to patients. It must be administered intramuscularly 4 times a day. Often, the drug is combined with Sigmamycin and Streptomycin.
After stabilization of the patient’s well-being, the dosage is gradually reduced, after which the introduction of antibiotics is completely canceled. After 1.5 months, the treatment is repeated.
Therapy is always supplemented with iron supplements and cardiac glycosides.
Complications
The outcome of rheumatic endocarditis directly depends on the timeliness of contacting a doctor. But even with a fast onset of recovery, negative consequences are often diagnosed.
The most common complications of rheumatic endocarditis:
- Chronic heart failure. The muscle stops pumping the required amount of liquid connective tissue.
- Thromboembolism. Against the background of blockage of the artery, a fatal outcome most often occurs.
- Persistent bacteremia. This, in turn, can also cause the development of various complications.
To eliminate the negative consequences, they most often resort to surgical intervention.
Forecast
Even in the absence of complications, rheumatic endocarditis leads to the fact that the patient becomes disabled. In 10% of patients, relapses are observed after several months.
According to statistics, the disease often leads to death. The mortality rate is up to 40%. With timely access to a doctor, the prognosis is more favorable.
Prevention
There are no specific measures to prevent the development of the disease. It is important to strengthen the immune system, regularly expose the body to moderate physical exertion and follow the principles of proper nutrition. In addition, it is important to treat identified diseases in a timely manner, especially rheumatism.
Finally
Under the influence of various negative factors, inflammation of the inner lining of the heart can occur. In this case, it is customary to talk about the development of rheumatic endocarditis. The disease takes several forms, but in the initial stages of development, it practically does not manifest itself. Due to this, patients most often consult a doctor at the stage of development of complications.