Rheumatic endocarditis is an ailment that affects the valves of the heart muscle. Therefore, many doctors call it rheumatic valvulitis. Rheumatic changes at the base of the valve occur very often, since the disease spreads through the fibrous ring from the myocardium.
Features of the disease
It should be noted that first in patients swelling of collagen fibers with further proliferative reaction is observed. In the early stages, the surface of the valve begins to change. At the points of contact of the valves, platelets and fibrin begin to accumulate and settle, which leads to the appearance of growths( warts).The valve tissue under the growths is edematous. Valves of the tricuspid valve are subject to rheumatoid changes two times less often than in the mitral valve. Later the valves are scarred, wrinkled and deformed, thickening or splicing of the walls is observed. This leads to the development of heart disease.
In consequence of rheumatic endocarditis, insufficiency or stenosis of the valves may develop. Insufficiency is called incomplete closure of valve flaps, and stenosis is the narrowing of its opening. The most common complication is the insufficiency of the mitral valve of the heart muscle.
Most often rheumatic endocarditis develops between the ages of six to sixteen, but recently a decline in the incidence of children has been documented. There are no specific features of the disease in children and adults, it proceeds in exactly the same way.
Clinical picture with rheumatic endocarditis
Species and forms
In the outbreaks of rheumatic endocarditis may be:
- Valve;
- near-wall;
- chordial.
The most common valve is considered. In turn, it is divided into four categories:
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The opinion of doctors. .. & gt; & gt;
- diffuse( valvulitis according to the classification of VT Talalaev).Damages valve flaps, but without the formation of growths;
- acute warty. It flows with damage to the endothelium and the formation of warts on the closing edge of valve flaps;
- is fibroplastic. It appears as a consequence of the two forms described above and is characterized by fibrosis and scarring;
- reciprocal-warty. Occurs repeatedly on the modified valve flaps. It is accompanied by a new appearance of outgrowths.
Causes of rheumatic endocarditis
The main cause of rheumatism is considered to be a beta-hemolytic streptococcus of the group A. In childhood, a patient with contact with him may develop pharyngitis or tonsillitis. Without consulting a doctor for qualified care, the disease goes by itself, but causes consequences.
Heart structures that most often affect rheumatic endocarditis:
- mitral valve;
- tricuspid valve( usually in combination with other localizations);
- aortic valve;
- parietal( parietal) endocardium;
- tendon chords;
- deep layers of the myocardium.
Therefore, with rheumatic endocarditis, the inflammation goes a little differently and differs from the infectious and septic species, although the primary cause of the appearance was the entry into the body of streptococcus. Pro symptoms and signs of endocarditis in children and adults read on.
Symptoms of
Symptoms of all forms of endocarditis are very similar and very often do not indicate exactly its rheumatic variety. When examining the patient, the cardiologist, as a rule, reveals:
- shortness of breath. Especially with physical activity;
- pain in the region of the heart. Not such a frequent symptom, can appear in the late stages of the disease;
- increased heart rate( tachycardia).The main distinguishing feature of endocarditis, it has nothing to do with physical stress and is completely independent of body temperature;
- nails in the form of watch glasses. Nail formations on the fingers widen and become more rounded, the central part of the nail plate builds up, forming a dome;
- fingers in the form of drumsticks( fingers of Hippocrates).A similar symptom may occur in patients at a late stage of the disease course. Characterized by the fact that the fingers become narrower, and the last phalanx widens. When rheumatic changes occur most often. But it happens in other diseases;
- pallor of the skin. With advanced stages of the disease, blue fingertips and nose can be blurred;
- fast fatigue. It manifests itself in the initial stages, especially with physical activity.
One of the main symptoms in the diagnosis of rheumatoid endocarditis can be a pronounced murmur that appears in the fifth week after the onset of the process.
When the blood test is taken, an increased number of white blood cells is detected. C-reactive protein appears and the content of fibrinogen increases. On the ECG there are discernible conduction disorders.
Diagnosis
When diagnosing rheumatic endocarditis, several methods are used:
- examination of the patient. It is performed by a therapist or cardiologist. Preliminary diagnosis is not available. It is necessary to detect out-of-cardiac symptoms of an ailment and an initial examination of the state of the cardiovascular system;
- analysis of laboratory results. Due to the analysis, mainly, the cause of the disease is identified. They can be a sufficient argument for diagnosing and prescribing treatment. To confirm rheumatic endocarditis, tests for the streptococcal antibody titer and rheumatoid factor must be submitted;
- bacteriological analyzes. Blood tests, detection of the causative agent of endocarditis;
- examination using medical equipment. Heart studies are performed using electrocardiography, echocardiography, radiography, ultrasound, magnetic resonance therapy and computed tomography.
Treatment of
Treatment of rheumatic endocarditis is carried out by all known methods and includes taking medications and fulfilling the doctor's prescriptions. With continuing to develop heart failure, surgical intervention is performed.
Therapeutic method
Includes the fulfillment of such physician requirements as:
- physical activity limitation or complete rejection of it;
- Avoidance of stress;
- diet, with the abandonment of salt, alcohol, spicy and fatty foods;
- quitting.
Medical method
This method of treatment of endocarditis involves the use of antibiotics, which are aimed at the complete destruction of beta-hemolytic streptococcus. As we have already mentioned, it is he who causes rheumatic changes in the heart. Intramuscular injection of benzylpenicillin is prescribed. Do it four times a day, for ten days.
After this, treatment with glucocorticosteroid drugs is prescribed. It is aimed at relieving the inflammation of the heart muscle. Prednisolone tablets of 20 mg per day are used, they should be drunk one by one after the morning meal. The main goal of the patient's taking these medications is to prevent the development of heart disease.
Operation
Surgical intervention is performed only in case of unfavorable development of the disease and if the patient's condition allows. Indications for the conduct:
- formation and accumulation of pus in the endocardium;
- continues to increase heart failure;
- massive growths on valve flaps;
The operation is performed by the method of opening the thorax and connecting the patient to the device of artificial circulation. The cardiosurgeon performs cleaning of the valves and removes the affected areas. If necessary, a decision is made to replace heavily damaged valves with artificial ones, but this is a separate operation.
Prevention of the disease and recommendations
To prevent the onset of rheumatic endocarditis, it is necessary to treat illnesses in time, in consequence of which it can develop. This is pharyngitis, tonsillitis and other diseases of the nasopharynx. It is necessary to worry and warn of exacerbations of these ailments.
Complications of
As we have already mentioned, the main complication of rheumatic endocarditis can be heart failure. Insufficiency or stenosis of the valves is a rather serious ailment leading to the replacement of the valve by a mechanical one. The most common complication is the insufficiency of the mitral valve of the heart muscle.
For the most frequent outcome of rheumatic endocarditis in children and adults, read last.
Forecast
About 25% of patients who underwent rheumatic endocarditis have no valve defects, especially in adults. In patients with this disease, the chance of contracting infectious endocarditis significantly increases, especially in the absence of prevention.
Even more useful information about rheumatic and other endocarditis types contains the following video release of the famous TV show: