Endocarditis - Causes, Symptoms and Treatment .MF .
Endocarditis - an inflammation of the inner lining of the heart (endocarditis).The heart is a muscular organ, whose main function is to ensure circulation.This body is made up of four chambers: the left and right atrium and right and left ventricle, separated by walls.Cardiac wall in its structure has three layers, each of which provides a specific function.The pericardium, or outside of the heart wall prevents excessive extension of the cavities of the heart during its relaxation.Myocardium itself or tunica muscularis heart pumping function provides that promotes blood circulation.Endocardium or inner shell lining of the heart chambers and ensures the smoothness and elasticity of the inner chambers of the heart.The main part of the endocardium - connective tissue is composed of elastic and collagen fibers.
structure of the heart wall
endocarditis is often not acting as an independent disease and is manifested as a result of the underlying disease.
Causes of endocarditis.
Depending on the cause
vegetations are formed on the valves of the heart
normal and damaged valve
primary endocarditis is initially endocardial inflammatory disease that can be caused by different microbial flora.The most common infective endocarditis is streptococcus.Just cause may be gonococci causing syphilis, meningococcus, E. coli, Mycobacterium tuberculosis, yeasts and viruses.The inflammatory process, which is caused by these pathogens, accompanied by the formation of vegetations (inflammatory proliferation of connective tissue in response to inflammation), which are most often localized on heart valves.vegetation data can be small and large sizes, they tend to be fragmented and exposed to the bloodstream to various organs.By the development of infective endocarditis predispose medical procedures, surgical or traumatic damage to the skin or mucous membranes.When removing teeth transient bacterial infection, usually strep registered in 18-85% of cases.Removal of the tonsils, nasal surgery is accompanied by a streptococcal infection.In recent years, increased the incidence of infective endocarditis in intravenous drug users, since the injections are a gateway through which the pathogen enters the bloodstream.As a special form of endocarditis allocate the majority of secondary forms - endocarditis prosthetic valve endocarditis occurs in patients with chronic kidney disease on hemodialysis, when infected venous catheters with a long stay in intensive care, endocarditis addicts.
Secondary endocarditis develops in diffuse connective tissue diseases, such as rheumatism, and systemic lupus erythematosus.The cause of endocarditis in these diseases is not fully known, it is established that the connective tissue is a target, which target the immune complexes formed as a result of cross-reaction and cascade mechanisms of the inflammatory response.Provoke endocarditis, systemic infections, such as syphilis and tuberculosis, which are based on a pronounced inflammatory reaction, which results in long-term consequences in the form of endocarditis.Medicinal endocardial lesions in the majority of cases are not fully clarified, although the development of some of them explain hypersensitivity reactions.It is necessary to emphasize that these reactions are often triggered by certain drugs, such as antibiotics, hormones and immunosuppressive.Effect of ethanol on the heart due to a direct toxic effect on cardiomyocytes.A wide range of kidney diseases, endocrine system and liver can cause a variety of complications of the heart.
symptoms of endocarditis.
A variety of symptoms that can occur with endocarditis, will depend largely on the cause of this pathology, we look at the most common symptoms.Fever is one of the first messengers of endocarditis.She used the wrong type, ie,the increase, the drop in temperature, there is often without any external cause, and continues day after day.When infectious processes, such as syphilis or tuberculosis, fever may not be a body temperature above 37.5 degrees.Typically, with a feeling of chill fever - from the stunning to feeling cold, chills on the back.
next group of symptoms of endocarditis - a skin manifestations.There may be a characteristic of patients with skin color "coffee with milk", and sometimes skin color pale or sallow.Also, rarely, usually in patients treated with the long-term, there is a symptom of "drumsticks" and "hour glass" - is clubbing of fingers and nails.The skin may show small subcutaneous hemorrhages in the axillary area, inguinal folds on the hips and abdomen.On a transitional fold of the conjunctiva may petechial hemorrhages.Currently, it is a rare symptom, but often very important, as the disease and its complications can be suspected by him.In the palmar surface, found on the soles of thick reddish-purple, painful to the touch nodules.
heavily for infective endocarditis is characterized by joint disease.Most often it is not symmetrical sharp defeat of the joints of the hands and the small joints of the feet.Much less affected large joints - knee, elbow.
to peripheral symptoms of the disease include weight loss and sometimes growing very fast (described example, when the patient has lost 18 kg in two weeks).Symptoms begin to grow at the wrong and ineffective treatment: there is shortness of breath on exertion.At first it does not interfere with the patient's life and work, but over time a person begins to feel that it is increasingly necessary to take breaks in work and rest that significantly reduces its efficiency.There are disruptions in the heart, one begins to feel and hear the abnormal noises.As a result of circulatory disorders appear periodic headache that subsides in a horizontal position.
diagnosis of endocarditis difficult due to the variety of the beginning of the disease, a variety of lesions very heart tissue and extracardiac manifestations.During a conversation with your doctor, he may ask you whether you are at risk (people who use drugs, people are often exposed to injections, healthcare workers, people with chronic infection).Characterized by the development of the disease after undergoing a sore throat or other respiratory infections.Certainly it is necessary to inform your doctor if you have recently had any surgical procedures.On examination, the doctor may discover you have an enlarged spleen and liver, abnormal sounds in the heart due to the malfunctioning of the valve apparatus.Isolation can increase systolic (upper) blood pressure.Blood tests will show your doctor the level of blood coagulation ability.Part of the donated blood must sow on special nutrient media, to identify the causative agent of endocarditis.Ultrasound imaging can help determine the degree of, and sometimes cause non-infectious endocarditis.Recording an ECG and chest X-ray can help rule out other diseases such as pneumonia or intercostal neuralgia.If any, any changes on the part of other bodies will require a consultation of experts as a cardiac surgeon, nephrologist, ophthalmologist and bacteriologist.
When this disease can not engage in self-traditional methods, it can lead to a tragic outcome.In case of shortness of breath, severe temperature that does not get off drugs, you should immediately consult a doctor or therapist cardiologist.The probability of infective endocarditis should always be considered in the differential diagnosis when prolonged fever.
treatment of infectious and non-infectious endocarditis.
main goal of treatment of endocarditis - suppress antibiotic therapy, or surgically removed inflamed tissue.In the formation of heart disease adjust it.Treatment extracardiac complications.For suspected infective endocarditis the patient should be hospitalized immediately for examination and treatment.Antibiotics are prescribed and only to the extent that the sensitivity is not less than 4 - 6 weeks.Typically prescribed a combination of drugs to achieve a significant effect.It can be a combination of ampicillin-sulbactam with gentamicin or vancomycin, vancomycin and ciprofloxacin.In addition to antibiotics in the treatment of infective endocarditis used drugs affecting the immune system and anti-infectious protection: immunoglobulin complexes glyuklkortikosteroidy in small doses.
For the treatment of bacterial endocarditis is not necessary to take into account the specifics of the underlying disease.In endocrine pathology is necessary to hand over analyzes on hormones and undergo treatment at the endocrinologist.Alcoholic and toxic endocarditis treated by the cancellation or termination of the use of a toxin.
Surgical treatment is the excision of the affected area of the heart valve prosthesis followed, with the ability to perform plastic surgery in order to save the patient's own valve.After a period of hospital treatment outpatient observation.Within 6 months you must pass monthly inspections to detect possible recurrence of infection and control of the general condition.In the subsequent examinations are held twice a year.
Complications that can occur when endocarditis.
main mechanism of complications is that the proliferation of the heart valves can come off and fly away with the blood flow to various organs and systems.Stuck in a small vessel caliber, they will cause an acute shortage of blood supply due to the death of a particular tissue.Kidney damage in the form of glomerulonephritis, renal and myocardial abscess.The defeat of the nervous system in the form of strokes, abscesses and meningitis.And the most serious complication - a pulmonary embolism, which can bring sudden death.
prognosis of endocarditis.
forecast remains serious endocarditis.If the patient is infective endocarditis of the right heart due to injection drug use, early treatment will increase the chance of survival by 85%.Endocarditis
fungal origin results in 80% mortality.
patients.who suffered endocarditis, have a very high risk of embolic complications and distant disease recurrence.
Since the main risk are drug addicts, it needs timely abstinence.People with artificial valves or chronic heart disease requires constant monitoring of the medical staff.It is important that patients are monitored medical equipment processing quality and interested physicians sterilization quality.Be healthy!
therapists Zhumagazy EN