Infectious endocarditis is a lesion of the tissue of the valvular apparatus of the heart and endothelium by various pathogenic and conditionally pathogenic pathogens. Most often, this pathology affects nevertheless heart valves. Today, this disease is more common with degenerative changes in the valves, but in some cases it can cause rheumatism. More often, the disease affects the mitral and aortic valves, and only a small number of patients can affect the right parts of the organ. They are often affected by drug addicts who inject drugs, or by patients using venous catheters.
Treatment of infectious endocarditis requires the right approach, so it is important to confirm the diagnosis as soon as possible and follow all the doctor's recommendations.
Causes
Microorganisms can cause the disease. Today, experts identify more than 100 pathogens, these include:
- streptococcus,
- staphylococcus
- enterococcus
- mushrooms and others.
There are intracardiac risk factors:
- congenital and acquired heart defects;
- the presence of artificial valves;
- sagging valve flaps;
- anomalies and structural features of the heart.
Causes of infectious endocarditis can also be extracardiac infections:
- the use of invasive methods of examination, when an accurate diagnosis requires penetration into the body;
- addiction with the introduction of funds inside with a syringe;
- secondary immunodeficiency, when the body's defenses are greatly reduced, and this happens if the patient does not control the intake of antibiotics or is often affected by an unfavorable environment;
- operations that affect the mucous membrane of the respiratory tract, intestines and stomach, urine diversion pathways, in the presence of infections in these organs.
Infectious endocarditis: classification
By origin, the disease is divided into primary and secondary form. Primary most often occurs in septic conditions against the background of the unchanged structure of the heart valves. If secondary infectious endocarditis develops, the valve and blood vessels already have changes against the background of congenital malformations, rheumatism, syphilis, and a medical history.
According to the clinical course, the following forms are distinguished:
- Acute lasts for two months, it seems that an acute septic state develops in the body, after severe injuries or manipulations of doctors on blood vessels, cardiac cavities: nosocomial angiogenic sepsis. It is characterized by a pathogenic microorganism, expressed septic symptoms.
- Subacute lasts about two months, develops if the treatment of acute infectious endocarditis was not correctly selected or the doctor’s recommendations were not followed by the patient.
- Lingering.
In people with drug dependence, the clinical characteristics of the disease are considered to be young age, rapid progression of ventricular failure on the right side, general intoxication, lung damage.
In people of advanced age, the disease can be caused by the presence of chronic pathology of the digestive system, foci of infection, and damage to the heart valves.
There are active and inactive forms. According to the degree of damage, the ailment proceeds with minimal damage to the valves of the heart valves or with a lesion that extends beyond them.
There are several main forms of infectious endocarditis:
- infectious-toxic - with it, the patient has bacteremia, adhesion of the microorganism to an altered endocardium, the formation of microbial vegetation;
- infectious-allergic, it is also often called by the doctors immune-inflammatory, it is characterized by clinical signs of damage to internal organs: hepatitis, myocarditis, nephritis and others;
- dystrophic develops at the moment when the septic process or heart failure begins to progress.
The dystrophic form is characterized by the development of severe and irreversible lesions of internal organs. In most advanced cases, patients have toxic myocardial degeneration with numerous foci of necrosis. Myocardium is affected in more than 90% of patients after prolonged infectious endocarditis.
What symptoms indicate endocarditis?
Most often, the symptoms of endocarditis appear after microorganisms enter the bloodstream. Depending on how many bacteria there are, how the body reacts to them, what special reactions a person has to infection, the disease can be active or not. This means that the symptoms of infectious endocarditis may be severe or may not even exist.
Also, the ailment can be complicated or uncomplicated. In the second case, the course of the disease does not cause a person any problems, but the complicated form can spread the infection to nearby organs. The body with endocarditis can respond to the infection with the following symptoms:
- high body temperature;
- rapid fatigue and fatigue;
- feeling of chills;
- weakness throughout the body;
- joint and muscle pain;
- excessive sweating, especially pronounced in the evening;
- swelling, most often in the lower extremities, in advanced forms can spread to the abdomen;
- malaise;
- dyspnea;
- in rare cases, skin disorders are observed.
To confirm the presence of infection in the human body, it is necessary to determine which of the bacteria "goes" through the bloodstream. Additionally, the patient may be forced to seek help if manifestations of anemia appear, blood is observed in the urine, the leukocyte level is above normal, and noise in the heart.
After the first symptoms of infectious endocarditis have appeared, you must always consult a doctor, undergo an examination and start treatment in a timely manner.
Diagnostic methods
To accurately diagnose "infectious endocarditis," you need to conduct a series of studies that will help identify the manifestations of the pathological process in the body. In typical cases, the diagnosis is based on such signs:
- the presence of fever;
- defects in the valves, manifested in the form of myocardial noises;
- thromboembolic complications;
- a positive result of a study on bacteria.
If you make an ECG, then you can see the manifestations of left ventricular hypertrophy on it, if the inflammatory process of the aortic or mitral valve is in the body. But hypertrophy of the right ventricle is observed when the tricuspid valve or pulmonary artery is affected.
Phenomena such as conduction disturbances, atrial and ventricular extrasystoles are also possible, in rare cases atrial fibrillation or flutter can be detected. An ECG helps to identify the disease at an early stage, which in the future gives a chance to successfully undergo treatment and avoid serious complications. You can check the work of the heart if you use a cardiovisor for diagnosis, which will make it possible to detect even minimal deviations in the work of the heart muscles.
Echocardiography is recommended for all patients who have suspected infectious endocarditis. Diagnostics will help to objectively assess the condition of the valves, detect calcification, rupture of valve flaps or chords, and distinguish the abscess of the valve ring. Often this technique is used to clarify the nature of heart disease, to determine the need for urgent surgical intervention, when valve failure is acute.
Blood tests are considered informative:
- general;
- biochemical;
- immunological.
A general analysis may indicate anemia, a shift in the leukocyte count to the left, but the most significant sign is a high level of ESR. Biochemistry reveals the presence of C-reactive protein, a high amount of fibrinogen, a low amount of albumin, an increase in the fraction of γ-globulins. Immunology will make it possible to detect rheumatoid factor, a high level of complement components.
It is also recommended to undergo blood cultures for sterility. But here it is very important to conduct a blood sampling correctly, the study can be carried out several times, so as to obtain more reliable data as a result.
To increase the effectiveness of treatment, it is important not only to establish a diagnosis, but also the form of the disease.
How does the disease manifest in childhood
Infectious endocarditis in children is very common. Symptoms of the manifestation of the disease can be as follows:
- acute toxicosis;
- endocardial inflammation;
- blockage of blood vessels by blood clots, which can also come off the myocardium affected by the disease.
In children with primary inflammation, the aortic and mitral valves are affected, and with a secondary ailment it affects the inner lining of the heart. Symptoms of the course of the disease are similar to those of an adult, but negative changes develop much faster, which leads to more severe damage to internal organs.
As a diagnosis, blood, urine, ECG, and pathogen screening are used.
As a treatment, large doses of Penicillin in combination with Gentamicin are recommended. But we must remember that the doctor and each specific patient must calculate the dose of each medicine, depending on his age and body weight.
In the immuno-inflammatory phase, the following are additionally taken: "Aspirin", "Ibufen", "Diclofenac" and other anti-inflammatory drugs.
For children, the prevention of infectious endocarditis is very important, in which sanitation of chronic foci of infection is used: tonsillitis, caries, sinusitis and others. Also, antibacterial therapy gives a good effect, especially in cases where the disease is accompanied by high fever.
If no measures are taken, then the complications will be much more serious than it might seem.
Complications
One of the most serious complications of infectious endocarditis can be considered embolism - the separation of a section of an overgrown valve, a blood clot and its further circulation through the arteries. The embolus will stop at the point where the diameter of the artery will correspond to its size. If the separation of a part of the valve occurred in the left part of the heart, embolization quickly develops in the vessels of a large circle, in which case the intestine, spleen or kidney may suffer. In them, the death of individual sites, or, in simple words, a heart attack occurs.
If the blood clot comes off on the right side, then the vessels of the small circle, the pulmonary artery, overlap, which means that pulmonary infarction develops. Also, due to endocarditis, other complications can be observed:
- heart failure;
- the formation of acquired heart disease;
- myocarditis;
- pericarditis;
- kidney damage
- damage to the spleen;
- vascular damage;
- malfunctions of the nervous system.
That is why it is important to urgently begin treatment and follow all medical recommendations. Infectious endocarditis can be fatal.
Therapeutic methods
First of all, if the patient has endocarditis, he needs to reconsider his diet, reduce salt intake. The treatment program consists of the following items:
- compliance with the regime;
- diet food;
- antibacterial treatment;
- immunomodulatory therapy;
- detoxification treatment;
- glucocorticoids;
- symptomatic therapy;
- surgical intervention.
After making an accurate diagnosis, the patient should be identified in a medical institution.
As for nutrition, after admission to the hospital, the patient is recommended to adhere to diet No. 10, which is characterized by a strict restriction of salt - not more than 5 g per day. In the future, when the indicators of inflammation and kidney function are normalized, you can include the usual dishes and more fresh vegetables and fruits in your food.
Antibacterial therapy is the basis for the treatment of infectious endocarditis. Reception of antibacterial agents should begin immediately after confirmation of the diagnosis. Antibiotics are used in large doses, which are administered intravenously. The course of therapy can be long - from a month to three.
The choice of drug and dose are selected in accordance with which of the pathogens has been identified, and what is its sensitivity to antibiotics. Patients are recommended penicillins, aminoglycosides, cephalosporins, but in most cases a couple of drugs are combined right away.
Most antibiotics are excreted through the kidneys and metabolized in the liver, so you need to adjust the dosage depending on how much these organs are affected in a particular patient.
If the antibiotic is selected correctly, then after 10 days after the start of treatment, a positive effect is noticeable. In some patients, resistance to antibacterial treatment may be observed, and this may be due to various reasons:
- therapeutic methods have been taken late;
- in the body there are several types of pathogens;
- use of an insufficient dose of the drug;
- immunodeficiency;
- the development of the disease in old age with the rapid generation of the disease;
- damage to several valves;
- endocarditis of artificial valves;
- the development of an ailment in people who are on hemodialysis or who use drugs.
In order for the treatment to have a positive effect, it is urgently necessary to revise the scheme of therapeutic measures.
Vital products of microorganisms and toxins suppress immunity. Antibiotics also lead to a similar effect, which for an infectious endocarditis of the heart take a long period of time. Therefore, you need to take all measures to maintain immunity:
- thymus preparations, which have an immunotropic effect, are recommended for use on a course of at least 10 injections;
- about 4 plasmapheresis and hemosorption procedures;
- up to 6 infusions of antistaphylococcal or anti-Pseudomonas aeruginosa;
- normal human immunoglobulin up to 10 infusions per course;
- ultraviolet irradiation of blood up to 7 procedures;
- laser irradiation of intravascular blood - 10 sessions.
To remove toxins from the body, “Hemodez”, “Reopoliglyukin”, “Glucose solution 5%”, a solution of “Sodium chloride” 9% and others are administered intravenously.
The etiology of infectious endocarditis is such that immune disorders may come to the fore, in which case glucocorticoid therapy may be required. For many years, the appropriateness of its appointment has been discussed, but there are several main indications for use:
- infectious toxic shock;
- severe immunocomplex syndromes;
- allergic to antibiotic;
- secondary antibiotic resistance.
Symptomatic treatment is also recommended:
- if joints hurt, then non-steroidal anti-inflammatory drugs can not be dispensed with;
- if circulatory failure develops, then diuretics, peripheral vasodilators and cardiac glycosides are recommended for use, but the latter are taken with extreme caution;
- with the development of thromboembolism, anticoagulants, antiplatelet agents and thrombolytics are prescribed;
- with anemia, iron preparations will be required;
- antihypertensive agents are recommended to reduce blood pressure;
- multivitaminotherapy is required;
- dysbiosis therapy is also needed.
In complex advanced cases, surgical intervention may be required.
Endocarditis Surgery
In some cases, surgery on affected valves cannot be dispensed with. The main goal of the surgical intervention is to eliminate the foci of infection that affected the valves. Affected valves in infectious endometritis are excised and replaced by a prosthesis.
The operation can be shown in cases where there are:
- rapid increase in heart failure due to a serious violation of the valve elements;
- complete resistance to antibiotic therapy;
- abscesses of the valve ring or myocardium;
- thrombosis in vital organs;
- artificial valve endocarditis;
- relapse of the disease;
- large mobile growths on the valves.
Timely surgery reduces mortality. But it can be performed only if endocarditis is an independent pathology, in other cases it makes no sense.
Forecast
Endocarditis is a serious ailment, the prognosis of which is unfavorable. In patients without immune deficiency, disease and heart disease, the disease can be treated, especially if therapy was started in the early stages. If a person falls ill with endocarditis, and in addition to it he has chronic heart diseases or the immune system is sufficiently suppressed, then complications that may endanger the patient’s life may develop.
The prognosis may worsen significantly if symptoms begin to appear after admission to the hospital within the first three days. If gram-negative microflora, Staphylococcus aureus, Cochiella and Brucella insensitive to antibiotics, fungal flora were seeded from the patient’s blood.
With damage to the right heart, the prognosis is more favorable. Rheumatoid endocarditis is also not life threatening.
Preventative methods
Prevention consists in the following activities:
- it is necessary to adhere to physical activity and proper nutrition in order to undergo examinations less and use invasive methods in treatment;
- it is important to identify foci of infection in a timely manner: to treat teeth, rinse tonsils with tonsillitis, ensure outflow from the sinuses of the nose with sinusitis;
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