Inflammatory heart disease: infective endocarditis

Infectious endocarditis - inflammation of the inner shell of the heart, heart valves, aortic wall. The classic causative agent of this disease is a green streptococcus. Previously, this disease was called subacute septic endocarditis. Most doctors considered it the final stage of development of rheumatism. Now, infectious endocarditis is considered an independent disease that affects both altered and undamaged endocardium.

In recent years, the incidence of infective endocarditis has increased several fold. This is explained by a decrease in the immunological reactivity of the population, as well as an increase in the virulence of pathogens as a result of irrational use of antibiotics. Men are more often ill, in half of cases, endocarditis infectious develops against the background of an existing heart defect.

Etiology

In the development of infectious endocarditis, streptococci, staphylococci, pneumococci, strains of salmonella, fungi are of great importance. Infective endocarditis, affecting the right heart, develops after repeated intravenous injections of drug addicts of substances of dubious purity. Another cause of right-sided endocarditis is the methods of endovascular cardiology. The disease often develops in patients with angiogenic sepsis, with suppuration of a thrombus located in the ventricle of the heart with transmural infarction.

The contributing factors of development are dental, gastroenterological and urological diagnostic and therapeutic procedures, burns, otolaryngological operations.

Clinical picture

Often infectious endocarditis appears imperceptibly for the patient. There is general malaise, weakness, fever with chills, headache. Sometimes the onset of endocarditis is acute and resembles malaria, brucellosis or typhus. In rare cases, the disease can begin with hemiplegia, back pain, speech disorders. This occurs as a result of embolism of the vessels of the brain, kidneys or spleen.

When examining patients determine the discoloration of the skin. She acquires a typical for this disease shade of coffee with milk, which is a manifestation of progressive anemia. Later on, edema and pastosity of the face appear. On the feet there is a hemorrhagic rash. Typical is the change of fingers: they take the form of tympanic sticks, and nails - watch glasses.

Patients complain of pain in the heart, dyspnea, palpitations. When aortic, mitral or tricuspid valve is affected, the corresponding symptoms of their failure appear. The defeat of the myocardium is manifested by a weakening of tones, tachycardia, proto-diastolic rhythm of the gallop, rhythm disturbances - arrhythmias, blockades. Perforation of the valve is possible.

Infectious endocarditis often affects the kidneys with the development of focal or diffuse glomerulonephritis, which is manifested by increased blood pressure, the appearance of edema, and urinary syndrome. It is possible to develop a spleen infarction, thromboembolism of pulmonary artery branches, and infarct-pneumonia.

Diagnostic tests

To diagnose endocarditis, ECG, echocardiography, chest X-ray are used. From laboratory studies, an overall blood and urine test is prescribed , blood culture for haemoculture.

Treatment

If infectious endocarditis is clinically suspected, treatment should begin immediately with the appointment of antibiotic therapy. Before determining the type of pathogen, the patient is prescribed broad-spectrum antibiotics. The administration of antibiotics should be intravenous and intramuscular.

The prognosis of the disease depends on the type of pathogen, its sensitivity to antibiotics, the presence of complications, the age of the patient.