Infective endocarditis is a disease that occurs as a result of the penetration of various microorganisms into the body. They are the cause of inflammation of the inner shell of the heart muscle( endocardium), as well as its valves. This is a rather serious disease with a high mortality rate. In men it is twice as common as in females. Endocarditis( infectious, rheumatic, septic, etc.) should be treated without starting!
Features of the disease
As an independent disease, infective endocarditis is very rare, often it occurs as a consequence of other diseases. You can get sick with such a disease at any age, and about one hundred and twenty-eight different microorganisms are considered potential pathogens.
- Recently, the incidence of infective endocarditis among young people has increased. This is due to the rather acute issue of drug addiction now.
- In infants, infective endocarditis develops as a consequence of congenital heart disease and related surgical operations.
- Elderly people can get a similar ailment due to degenerative-dystrophic changes in the valves of the heart muscle.
Infective endocarditis( photo)
Classification of infective endocarditis
Infective endocarditis( IE) is classified into several categories.
Internal and external factors
Internal and external manifestations:
- Primary infective endocarditis. Such a disease occurs on intact valves of the heart and can lead to their destruction;
- secondary infective endocarditis. It appears due to the presence of congenital abnormalities of the valves of the heart muscle, rheumatism, atherosclerosis and previous infectious endocarditis.
On the peculiarities of infective endocarditis, its typology and manifestations, the following video will tell in detail:
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Exciter types
By type of pathogen:
- enterococcal;
- is staphylococcal;
- streptococcal.
Pathogens can be many, classify only the main ones.
The course of the disease
Down the ailment:
- acute infective endocarditis. It takes less than two months;
- subacute infective endocarditis. The duration of the disease is more than two months.
Location
Accepted among cardiologists classification( proposed in 2009 by the European Society of Cardiology).By location:
- right-hand;
- left-sided own valve;
- left-sided prosthetic valve. It happens early( less than a year after the operation to install the prosthesis) and later( after the prosthesis was installed more than one year);
- The IE is associated with intracardiac devices( eg, a pacemaker).
Form of acquisition
By acquisition:
- as a result of medical care. In this case, infective endocarditis is divided into hospital( nosocomial) and non-hospital( not nosocomial).The first develops more than two days after the patient's admission, and the second, respectively, in the period up to forty-eight hours;
- is out-of-hospital;
- associated with intravenous administration of drugs and various drugs( mainly occurs in addicts).
Infective endocarditis in the aortic valve( scheme)
Causes of
Many infectious endocarditis is caused by many known bacteria that are pathogenic. In most cases this is:
- Staphylococcus aureus;
- enterococcus;
- streptococcus;
- mushrooms.
On what symptoms of infective endocarditis in adults and children, read on.
Symptoms of
In some cases, and especially in elderly and weakened patients, the symptoms of an illness may be absent. Very often, IE occurs with various complications, the symptoms of which can also manifest themselves only at a late stage.
The main symptoms of infective endocarditis:
- lack of appetite;
- chills;
- fever;
- weight reduction;
- of the Rota spot. Small hemorrhages in the retina of the eye, which are detected on examination by an ophthalmologist;
- submucosal and subcutaneous hemorrhage.
On the diagnosis and standards of treatment of infective endocarditis, read on.
More details on the diagnosis and symptoms of infectious endocarditis will be told by specialists in the video below:
Diagnosis
Diagnosis of the disease is based on:
- full analysis of the history of patient complaints and complaints;
- analysis of the anamnesis of life. Doctor's elucidation of the details of the illnesses of the patient's relatives, the social behavior of the patient;
- physical examination. It includes examination of the skin and mucous membranes of the patient. Listening to noise in the heart and measuring blood pressure;
- biochemical blood test;
- blood and urine test;
- determination of the clotting factor( coagulogram);
- immunological blood test;
- blood culture to identify the causative agent of infective endocarditis. Also, this analysis allows you to determine what type of antibiotics the antibiotic reacts to. The most reliable samples will be those that are taken twice at intervals of twelve hours or three times from intervals of thirty minutes. At an elevated temperature in a patient, the chance to detect a pathogen in the blood increases;
- polymerase chain reaction. One of the most effective methods of diagnosis, in which the material for analysis is taken from the valves of the heart right during the operation. Of the disadvantages, it should be noted that a positive result can persist for a month after the disappearance of the microorganism-pathogen;
- electrocardiography. Such a study will show a violation of the rhythm of the heart;
- blood test for the presence of D-dimer( blood clot decay product);
- phonocardiogram. This type of diagnosis detects heart noises in the projection of the valves;
- radiography. A review study helps diagnose infective endocarditis;
- echocardiography. Together with the sowing of blood, a similar method of diagnosis is the main one in detecting the disease. Infective endocarditis is determined on the basis of three criteria: vegetation( blood clots with microorganisms that are attached to valves and other internal surfaces of the heart muscle, as well as implanted medical devices), abscesses( cavities near the valves filled with pus) and insufficiency of the prosthetic valve;
- transesophageal echocardiogram;
- magnetic resonance imaging.
Treatment of
If the taken blood sample for seeding was positive, then the treatment should be started immediately. Now let's talk about the therapy of infective endocarditis.
Medication and therapeutic treatment
It is prescribed depending on the variety of the infectious endocarditis pathogen identified:
- treatment with antibiotics. It can last from four to eight weeks and depends on the type of microorganism that caused IE, and its sensitivity to the effects of medications. The state of the cardiovascular system and the presence of complications of the disease also affect the treatment process;
- glucocorticoids. Are appointed in the event of complications from infective endocarditis, in particular, involvement of the immune system, vasculitis, arthritis and other diseases;
- antifungal drugs;
- drugs that interfere with blood clotting and the formation of blood clots( antiaggregants).
Next, we will tell you about the features of the operation in the diagnosis of infectious endocarditis.
More details on the diagnosis and treatment of infective endocarditis will be reported by the famous physician in the following video:
Operation
Surgical intervention in infectious endocarditis is urgent, urgent and delayed.
- The first two types of surgery are performed in the event of heart failure or uncontrolled infection.
- With delayed surgery, drug treatment is first performed.
When performing surgery from the heart muscle, the structures containing the IE pathogen are completely removed. The second stage is the restoration of damaged by the microorganism of the components of the heart. Most often - it is the replacement of valves. Every tenth case of surgical intervention in infectious endocarditis results in a fatal outcome.
Extracorporeal method
With this method of treatment, special devices are used that affect the patient's body, change the properties and composition of the blood. Remove the patient's blood from the blood of the compound from the protective complexes of the body and foreign substances.
Next we will tell you about the clinical recommendations for infectious endocarditis, its treatment and prevention.
Prevention of disease and recommendations
Prevention of infectious endocarditis is carried out only in patients with a high probability of an illness. These include:
- patients with replaced heart valves;
- person with a previously emerging IE;
- patients with congenital heart disease.
To prevent infectious endocarditis, antibiotic therapy is used.
Cardiologists are advised to take antibiotics that will reduce the risk of IE, along with preventive measures, after any surgical intervention.
Note that many countries have their own, national recommendations for infectious endocarditis. For our state, they are registered in a special document of the Ministry of Health and Social Development of Russia GBOU VPO( you can download here).
Complications of
Complications that may occur after infectious endocarditis:
- stroke;
- kidney failure;
- heart failure;
- abscesses of the heart muscle;
- repeated infections;
- septic shock;
- disruption of the heart valves( with the need for surgery);
- bleeding disorder;
- atrioventricular block;
- pneumonia.
Forecast
With timely diagnosed infectious endocarditis and correct treatment, the five-year survival rate of patients reaches eighty five percent.
To a greater extent, the prognosis depends on the behavior and aggressiveness of the pathogen and the individual tolerability of the patient.