The main causes of endocarditis are:
- Infection – bacteria (streptococci (especially Streptococcus viridans, in 80% of cases), staphylococci, enterococci, E. coli, Pseudomonas aeruginosa), fungi, in rare cases, viruses and protozoa;
- Bacteremia – the presence of bacteria in the blood;
- Endocardial damage – injuries, surgical treatment of the heart;
- Allergic reaction;
- Intoxication of the body (for example, with uremia);
- The presence of artificial heart valves, trauma to the myocardial valves;
- Various diseases – myocarditis, pericarditis, syphilis, tuberculosis, brucellosis, HIV infection, acute respiratory infections, allergies, furunculosis, osteomyelitis, caries;
- Decreased reactivity of the immune system – usually develops as a result of alcohol or drug addiction, constant stress, hypothermia, uncontrolled use of certain drugs, hypovitaminosis, the presence of chronic diseases.
According to doctors diagnosing endocarditis, the causes of the disease are diverse. Moreover, the nature of pathological factors varies depending on the type of infectious endocarditis. The main violation, which often acts as a trigger for the development of pathology, is endocardial damage by turbulent blood flow in congenital and acquired heart defects.
As a pathological factor in primary infective endocarditis, bacteria and microorganisms act. With massive bacteremia, they settle on the surface of the heart valves, leading to the development of the disease. These changes entail infiltration by cellular elements, fibrin deposition according to the type of warts or polyps – polypous ulcerative endocarditis.
In most cases, adhesion of microbes on the surface of the endocardium is promoted by previous heart lesions, previous heart surgeries.
The following types of bacteria act as pathogens:
Secondary forms develop on the basis of existing heart lesions. Thus, infectious endocarditis of the mitral valve is a consequence of the presence of prolapse with its pronounced insufficiency. Among other possible causes of secondary endocarditis:
- hypertrophic cardiomyopathy;
- heart defects (coarctation of the aorta);
- decreased immune forces of the body;
- prolonged use of central venous catheters;
- the presence of intracardiac electrodes.
A variety of factors can provoke infectious endocarditis. Their recognition guarantees a positive effect from the treatment. The main causes of the inflammatory process in the endocardium are:
- ailment of connective tissue of a diffuse nature;
- chemical poisoning;
Small clusters of bacteria may form at the site of infection. These bacterial accumulations can block blood flow and restrict blood flow to the heart. The heart, which plays the role of a pump in the body, drives and distributes blood throughout the body.
As a result, circulatory disorders can seriously affect the functioning of other organs, which will lead to their failure.
Microorganisms that cause endocarditis arise from infection sites, for example:
- skin abscesses;
- during central or peripheral venous catheterization;
- urinary tract;
- wounds, cuts;
- oral cavity.
Especially in adult predisposed individuals, endocarditis is secondary to invasive dental, medical, or surgical procedures.
In 90% of cases, the bacteria involved are staphylococci and streptococci, while 10% are enterobacteria, gram-negative bacteria and microorganisms of the HACEK group.
At the valve level, microorganisms form the so-called “vegetation” of infectious nuclei, which are coated with fibrin and platelets, which allows bacteria to protect themselves from the immune system and from antibiotics.
From this vegetation (vegetation), the fungal emboli can then separate and cause distant complications in various organs (skin, eyes, kidneys, lungs, etc.).
Endocarditis is a relatively rare disease among healthy subjects (people), however, the risk is quite high in specific subjects (especially men) in the presence of the following risk factors:
- congenital heart defects (atrial defect, interventricular defect, open ductus arteriosus);
- the presence of artificial valves or other intracardiac devices (e.g., pacemakers);
- valvular pathology (prolapse, stenosis, failure);
- the presence of central or peripheral venous catheters;
- immunocompromised subjects (i.e. people with a weak immune system);
- drug addicts who inject drugs;
- sepsis (generalized systemic infection with the presence of pathogens in the blood).
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- Endocarditis Classification
- Endocarditis leffer
- Endocarditis in children
- Manifestations of endocarditis
- Skin diseases
- Infectious endocarditis – symptoms
- Disease in young patients
- Diagnostic research
- Diagnosis of endocarditis
- Therapeutic activities
- Endocarditis treatment
- Endocarditis Prevention
Endocarditis can be divided into 3 forms:
- Subacute endocarditis: it is treacherously developing and slowly progressing for several months. The subacute form is primarily caused by Streptococcus Viridans, vermin streptococcus (present in the oral cavity) and Staphylococcus aureus. This type of endocarditis often develops on pathological valves due to invasive dental or other procedures or after gastrointestinal or genitourinary infections.
- Acute endocarditis: a very aggressive form that develops rapidly over several days. Staphylococcus aureus is the most common etiological agent, and its complications can be quite serious, leading to death.
- Endocarditis of prosthetic valves: occurs in subjects who have undergone valve replacement (especially aortic or mitral), both in the case of mechanical and biological prostheses.
Causes of Bacterial Endocarditis
The causes of endocarditis are divided into two large categories, depending on many factors:
- Primary endocarditis.
- Secondary endocarditis.
Diseases of the first group are caused by microbiological flora. The pinnacle of popularity is streptococcus – a very underrated and dangerous opponent of human health. Gonococci become the causes of the disease, which can also be the cause of diseases such as syphilis, meningococci, E. coli.
Then vegetations, dangerous inflammatory processes in the connective tissue are formed. A process occurs in the valves of the heart, dangerously approaching the main muscle of a person. A dangerous feature of endocarditis is the ability to move vegetations to any organs of the body with a blood stream.
The cause may also be surgical intervention in the affected organ. When removing teeth, the chance of a bacterial infection – 18-85%. When removing tonsils – a chance of streptococcal infection at 100%.
The second category of endocarditis is formed during diffuse processes of connective tissue. These include rheumatism and similar human ailments. The inflammatory reaction is more pronounced.
Types of endocarditis are numerous, which seriously complicates the diagnosis.
The disease is polyetiological. Activation of infection in the connective tissue that lines the cavity and valves of the heart leads to an inflammatory-infectious process. The pathogen can be more than 120 microorganisms.
The main place among them is:
- hemophilic infection
- klebsiella and others
In the largest number of patients, Staphylococcus aureus is isolated as a pathogen. In a healthy person, the internal tissues of the heart are immune to the action of the bacterial flora and cannot serve as a substrate for their colonization.
Two main mechanisms can contribute to infection:
- mechanical damage to connective tissue in the presence of electrodes and catheters in the heart
- ingestion of highly virulent strains that have strong adhesive properties
Connective tissue diseases are accompanied by an inflammatory process and the response of the body’s immune system. As a result of this, immune complexes enter the endocardium and typical stages of the fight against inflammation develop – the production of tissue factor, deposits of fibrin and platelets. Changing the structure of the endocardium and the appearance of heterogeneity of the tissue facilitates the adhesion of bacterial pathogens when they enter the systemic circulation in any way.
Mechanical damage to heart tissue results in an appropriate response of the immune system and the transport of extracellular matrix proteins to the area of damage. Tissue healing is accompanied by heterogeneity of the connective tissue and an increased likelihood of infection.
The presence of a strong allergic reaction contributes to the release of a large number of biologically active substances into the systemic circulation. Inflammatory mediators damage the vascular endothelium, as well as heart tissue. Over time, a hemodynamic disorder occurs and the inflammatory process develops on the endocardium.
Non-infectious endocarditis reduces the protective properties of the inner layer of the heart and creates favorable conditions for the colonization of bacteria. The body’s response to inflammation leads to the formation of fibrin-platelet regions, which are more susceptible to pathogens than the original endocardial tissue. Eosinophilic endocarditis is often isolated in a separate form of the disease, but it has not yet been fully studied.
Intoxication endocarditis develops as a secondary non-infectious lesion. In the absence of proper treatment, it leads to a change in the structure of the endocardium and the susceptibility of tissues to adhesion of pathogens. Intoxication endocarditis is not an independent disease, but acts as a consequence of other pathologies.
The infection in the endocardial cavity contributes to the appearance of primary infectious endocarditis. In this case, as a rule, a person has provocative factors that increase the ability of pathogens to attach to connective tissue.
In the clinical picture, typical symptoms of sepsis are observed, leukocytosis occurs in the blood and ESR increases. The causative agents of infectious endocarditis are exogenous bacteria and toxins that enter the systemic circulation and reach the main organ.
Infectious (aka septic or bacterial) endocarditis – develops under the influence of pathogenic microflora.
Acute bacterial endocarditis – refers to the complications of general sepsis. This version of the disease differs little from the subacute form, except that it occurs under the influence of an acute septic state, or surgery on vessels and cavities of the heart, or serious injuries.
A more acute course of this type of endocarditis makes it dangerous. Most often, the patient immediately goes to the dispensary and goes through a cycle of examinations during the week.
The complexity of the treatment is relatively low, but early diagnosis of the disease is too important.
Subacute infectious endocarditis is a systematic process that belongs to the category of infectious and inflammatory. Immune violation occurs, the heart valves are affected.
Most often, both valves suffer, but there are currents only in the orthal or only in the mitral valves. The disease develops slowly. The absence of a purulent focus worsens the ability to diagnose and detect the disease at an early stage.
The most popular pathogen is verdant streptococcus, in its account 80% of cases of diseases. Less commonly, the cause of the disease is Escherichia coli, or Proteus.
This category of inflammatory diseases of the endocardium includes: minimal, abacterial, degenerative verrucous and other forms of endocarditis.
The causes of the development of endocarditis of this type can be poisoning and general weakness of the body.
Rheumatism can be the cause of endocarditis, which further leads to the development of heart defects. The inflammatory process extends to the connective tissue of the valves, tendon chords, parietal endocardium.
Rheumatic endocarditis is divided into four separate types of disease:
- Acute warty – such endocarditis is characterized by damage to the endothelial tissue in the deep layers. The name “warty” is due to the characteristic gray-brown formations (tubercles-warts). In the absence of treatment, growths grow and unite in clusters – acute polypous endocarditis.
- Recurrent-warty – the same as acute warty endocarditis, only formations appear on the valves already affected by sclerosis.
- Simple (diffuse) – only tissue swelling occurs without deep damage to the endothelium (valvalitis Talalaeva). Treatment should be started as soon as possible, since at the beginning of the disease there is a high probability of restoration of the normal structure of the endocardium. In advanced cases, it passes into the fibroplastic type of endocarditis.
- Fibroplastic – is a consequence of any of the above forms of endocarditis. If the disease goes into this form, then the patient faces serious complications and persistent pathological changes in the endocardium.
The disease leads to a thickening or narrowing of the heart chambers. Very often, the myocardium is also affected by the inflammatory process, which leads to heart failure.
- Acute (necrotic) – inflammation spreads to the ventricle and upper part of the heart muscle. Entire foci of dead cells are formed, which occur even in the vessels of the internal organs and skin. This stage takes about 1-1,5 months.
- Thrombotic – the endocardium of the left ventricle is affected, part of the muscle fibers hypertrophy, the rest on the contrary atrophies. Sclerosis develops.
- Fibrosis – narrowing of the chambers and scarring of the tendon chords contribute to the development of heart disease. Pathological changes affect not only the endocardium, but also adjacent vessels.
Endocarditis in children
It is rare. In 85% of cases, it is infectious endocarditis. Symptoms include acute toxicosis, severe endocardial damage, and vascular obstruction.
The inflammatory process affects the entire inner lining of the heart. In general, the picture is similar to the symptoms of adults, but due to the fact that the body of children is not yet formed, everything happens more randomly.
To prescribe the correct treatment for infectious endocarditis, it is necessary to determine the pathogen, understand the degree of organ damage, the severity of the course, the presence of concomitant pathologies and other indicators. For this, the disease is classified into several categories.
According to the anatomical features:
- Primary – a new lesion of previously unaffected heart structures
- Secondary – infection occurs on structures that are already pathologically altered
- Orthopedic – infection occurs on artificial valves
According to the clinical picture:
- Active endocarditis – easily diagnosed and contributes to clinical symptoms
- Inactive – the disease is hidden, signs of inflammation may not be detected in laboratory tests
By the presence of complications:
- Cardiac complications
- Complications that appear in other organs – the lungs, peripheral vessels, the brain, and others
There are also several forms of the disease.
From the onset of the disease to severe clinical manifestations, no more than 2 months pass. Pathology often develops as complications of sepsis, trauma or surgical interventions in the cardiovascular system. Clinical symptoms with this form are quite pronounced, the pathogen is highly pathogenic and threatens the patient’s life.
From the onset of the disease to the characteristic clinical picture, more than 2 months pass. Symptoms are not as intense as in acute form. Subacute endocarditis is often the result of an untreated acute form or underlying cardiological disease.
Endocarditis goes almost to the chronic stage – inflammation and infection affect a fairly large area of the heart. In this case, treatment is carried out for a long time, and the result is difficult to achieve, since it is quite difficult to defeat the pathogen.
This form occurs when the patient is irresponsible to his health, in which he does not go to the doctor for a long time or does not finish the prescribed treatment regimen. Also, this is possible with prolonged immunosuppressive therapy.
This condition is characterized by symptoms of damage to the heart valves. In the first stages of development, rheumatoid endocarditis does not cause any serious manifestations. It is possible to establish an accurate diagnosis only during a thorough cardiological examination and according to the results of laboratory tests. The formation of the disease at a late stage leads to the formation of symptoms of insufficient heart function. Rheumatic endocarditis and its signs begin to affect other organs and systems.
The ailment is often limited only by manifestations of the heart. Therefore, patients do not feel any serious manifestations characteristic of endocarditis.
Septic endocarditis is a special form of sepsis, characteristic of which is damage to the heart valves. Bacterial endocarditis is classified by the nature of the course or presence of an accompanying disease.
Given the nature of the development of the inflammatory process, acute, subacute and prolonged septic endocarditis is isolated. The acute form lasts about 14 days, subacute – 3 months, protracted – bothers people for months and even years. Today, doctors note that the acute forms are gone, so they diagnose subacute and protracted. Bacterial endocarditis, taking into account the background pathology, happens: primary and secondary.
Hemorrhage in the conjunctival eye
Septic endocarditis is manifested in the following form:
- hemorrhage (blood flow from blood vessels) into the conjunctiva of the eyes;
- on the palms thickenings are formed in the form of nodules;
- exhaustion of fingers;
- hemorrhage in the skin.
Primary (infectious endocarditis – IE, active) – the disease is caused by infection of the endocardium. Usually, inflammation develops against the background of bacteremia – bacteria that circulate in the blood, which are able to adhere to valve flaps due to various secondary factors.
Secondary (non-infectious endocarditis) – various pathological conditions, especially the health of the body, trauma, congenital heart disease, defect of the septum of the heart, valve prosthetics, etc. become the cause of the inflammatory process. Often this type of pathology is complicated by infection. In this regard, this type of disease is divided into:
- Fibroplastic with eosinophilia;
- Traumatic (this includes postoperative).
Acute (septic infectious endocarditis) is an inflammatory process, lasting up to 2 months, develops against the background of septic lesions of the body, which is why in the endocardium. It is characterized by an acute course and severe symptoms of the inflammatory process, accompanied by infectious toxic manifestations with frequent purulent formations, sometimes spreading to other tissues and organs.
Subacute IE – continued development of the acute phase of IE, – a consequence of the prolonged course of sepsis for 2-6 months. Long-term exposure of the body to an infection causes embolism, recurrent septicemia, changes in the functioning of the immune system, which is why secondary diseases such as nephritis, synovitis, vasculitis, and polyserositis develop. With adequate therapeutic measures, the disease does not reach this stage.
Chronic IE (prolonged, recurrent) – the development of the inflammatory process for 6 months or more, in which the clinical manifestations are reduced, there are no purulent formations and metastases from them. At this stage, the immunopathological manifestations associated with the defeat of circulating immune complexes (CECs) predominate. With the appearance of provoking factors, the inflammatory process escalates.
Latent – a rare variant of the course of the disease, in which the symptoms are so mild that the patient goes to the doctor during the decompensation phase of heart disease.
Endocarditis of native valves, may be:
- Primary (diagnosed in 40-65% of cases) – due to infection of the body and is characterized by difficulty in diagnosing, severe course and high mortality;
- Secondary – due to congenital or acquired heart disease, injuries, surgical treatment of the myocardium.
Manifestations of endocarditis
Symptoms of endocarditis appear equally in all patients at various stages of the disease. According to them, it is not possible to recognize the cause of the disease, but they arise against the background of a lack of oxygen in the tissues. To make a diagnosis, patient complaints alone are not enough, as the symptoms are very similar to other pathological conditions.
Infectious endocarditis has the following manifestations:
- increase in body temperature
- increased sweating;
- skin diseases;
- eye manifestations;
- pain in the muscles and head.
Such a symptom is found in almost all people affected by infectious endocarditis. Initially, the temperature indicators are moderate – 37–37, 5 degrees. A few days later they reach a dangerous mark of 39-40 degrees. This condition is due to the characteristics of the pathogen.
Very often, a fever is a consequence of the influence of specific components. In the inflammatory process in the inner shell of the human “motor”, these substances act as pathogen vital products. After penetration into the plasma, they affect the center responsible for thermoregulation, and cause a rise in temperature.
Complicating the diagnosis is the fact that a slight increase in the temperature regime is not accompanied by heart symptoms. The fever lasts for 3-4 weeks.
This condition involves an involuntary contraction of muscle tissue, manifested in the form of trembling or convulsive state. Chills are a characteristic manifestation of sepsis, as a result of which there is a movement of bacteria in the plasma and their defeat of internal organs. Infectious endocarditis manifests itself in the form of chills at the time of an increase in body temperature.
The root cause of a person starting to sweat a lot is a fever. The release of sweat contributes to the decline in the temperature of the victim. With sepsis, which causes infectious endocarditis, this symptom disturbs the victim, usually at night.
Since harmful agents of an infectious nature affect the heart with a rush of blood, then most people with endocarditis can detect damage to the vascular walls. Manifestations of this condition are the formation of a small rash on the skin, redness.
The mechanism of the formation of eye symptoms is similar to skin. They include a number of signs that form point bleeding in the eye area. The patient can detect such a sign in himself. The pathological process is manifested by red pigmentation on the conjunctiva of a small size. You can detect them yourself if you move the lower eyelid down.
When examined by an ophthalmologist, Roth spots may be noticed. They are areas of hemorrhage that affect the fiber of the eye. It is possible to identify them only during the diagnosis of the fundus.
Symptoms of this kind are visited by people who have infectious endocarditis. If a person was struck by another form of the disease, then he does not have headaches and muscle pains. The causes of such formations are intoxication of the body caused by the multiplication of microbes. Often they coincide with the first stage of temperature increase.
Infectious endocarditis – symptoms
The course of the disease can occur with minimal signs, or even without them, which largely depends on the state of human health and the severity of pathological factors involved in the development of endocarditis.
General – weakness, malaise, soreness, elevated and high body temperature (38,5-39,5 ° C), severe chills, profuse sweating, rheumatism, headache, pain in muscles and joints, anorexia, arthralgia.
From the cardiovascular system – heart pain, pronounced heart murmur, myocarditis, pericarditis, abscesses, aortic and mitral valve damage, heart decompensation, thrombosis, thromboembolism, vasculitis, aneurysm, increased fragility of blood vessels, minor hemorrhages in the mucous membranes (conjuncture and etc.).
From the side of the central nervous system – meningitis, cysts, acute cerebrovascular accident (stroke), psychosis.
On the part of the skin – the acquisition by the skin of a pale gray-yellow color, abscesses, purple, Osler’s nodules, hemorrhage.
From the side of the kidneys – nephritis, glomerulonephritis, hematuria, proteinuria, abscesses.
From the lungs – abscess, pleurisy, pneumonia, polyserositis, empyema.
Other signs are enlarged lymph nodes, arthritis of the joints of the hands and feet, polyarthritis, changes in the structure of the nail plates and phalanges of the fingers (a symptom of “drum fingers”), heart attacks (myocardium, kidneys, spleen, lungs, intestines), angina pectoris.
Blood tests show – leukocytosis, an increase in ESR, severe hypochromic anemia, circulating immune complexes. Monocytosis, increased α2- and γ-globulinemia, C-reactive protein, thrombocytopenia can also be observed.
Symptoms of endocarditis are always based on the cause of the disease. The first messenger of endocarditis is fever. It can be confusing and chaotic – it rises or decreases the temperature, you don’t see the external causes of the temperature change and you don’t know how to fight for its decrease or increase.
With syphilis and tuberculosis, the appearance of endocarditis is not manifested by fever, and the temperature is unlikely to cause feelings – usually it rises only to 37,5 degrees.
A striking symptom is a change in skin color to the shade of “coffee with milk”, but less often the shade can be pale or earthy. Such changes scare people enough to go to see a doctor.
Most likely, symptoms appear only a week or two after infection, but powerful strains of the infection can cause a more rapid development of the disease and its severe course. The first signs may resemble ordinary flu or SARS – high fever, weakness, chills.
The palms of a patient with infectious endocarditis.
Symptoms of endocarditis are possible:
- sweating, especially at night;
- weight loss;
- muscle or joint pain;
- bouts of severe coughing;
- hemorrhages under the nails and skin (spots – petechiae), on the mucous membranes, the fundus;
- painful seals of the fingertips (Osler nodules);
- skin rashes.
For the disease, in addition to signs of sepsis, severe intoxication with headaches, an increase in the spleen and liver are characteristic. Blood tests detect leukocytosis, anemia, increased ESR. Bacterial embolism of various organs with the formation of purulent metastases can be observed.
Heart tones are muffled, new sounds are added to the heart, arrhythmia begins. If the infection is not eliminated in time, then endocarditis acquires the features of acute heart failure.
Note that high fever, nausea, aches and muscle pains and some other symptoms may not be present. However, it is not difficult to diagnose the disease – a blood test is used, since pathogens are found in arterial blood.
Usually, symptoms begin to appear 2 weeks after the activation of the microbe in the endocardium. The range of clinical manifestations is quite wide – from erased signs to acute intoxication.
First, there are symptoms that are characteristic of any infectious process:
- fever and chills
- weakness and fatigue
- muscle and joint pain
- weight loss
Additional signs are:
- warm dry skin
- enlarged spleen
- trophic disorders – dermatological peeling, brittle hair, vasculitis
With the transition of pathology to the subacute stage, multiple organ failure occurs in the body, due to which symptoms can manifest themselves in disruption of various organ systems.
The ingress of bacterial toxins into the bloodstream is manifested by weakness, shortness of breath, sudden weight loss, and fever. Violations of the gastrointestinal tract lead to the appearance of anemia, earthy skin color. The defeat of the vascular system leads to hemorrhages on the skin, in the oral cavity, conjunctiva of the eyes. Capillaries become so brittle that they can be damaged even with minor skin injuries.
Endocarditis can be distinguished from respiratory infections by the presence of cardiac lesions. The patient has functional noises, myocarditis, heart failure is detected. In instrumental studies, valve defects are detected.
A long course, starting from the subacute form, leads to circulatory disorders, which negatively affects the work of other organs due to insufficient intake of nutrients and oxygen. Brain vascular embolism, blood clots in the spleen, and inflammation in the kidneys and liver may occur.
The spread of the bacterial pathogen through the circulatory system often leads to the subsidence of the pathogen in the muscles and blood vessels, which causes polyarthritis. Other external manifestations of the disease can be impaired consciousness, cerebral complications, suffocation, cyanosis.
Specific symptoms in the long course of the disease are changes in the shape of the phalanges of the fingers and nails. The first take the form of drumsticks, and the nails are rounded.
Symptoms of endocarditis can be general in systemic type:
- night sweats;
- general malaise with weakness;
- loss of appetite and weight loss;
- arthro-myalgia (pain in joints and muscles);
- chills and pallor.
The most specific and typical symptoms of endocarditis:
- Roth spots: hemorrhagic lesions of the retina caused by embolisms originating from infectious vegetative lesions of the heart (see photo above);
- skin petechiae: small red spots on a large surface of the body;
- Osler’s nodules: painful subcutaneous nodules at the fingertips;
- signs of Janeway: hemorrhagic spots on the palms of the hands and soles of the feet;
- fragmentary hemorrhages under the nail (see photo above).
Complications of endocarditis ultimately affect distant organs, including:
- Central nervous system: mycotic embolism at this level can cause:
- transient ischemic attack (TIA);
- stroke ;
- brain abscess or subarachnoid hemorrhage;
- pleural empyema;
- lung abscess
- pulmonary infarction;
- pleural pain;
- hemoptysis (the presence of blood in sputum removed with a cough).
- Heart: Severe valve dysfunction can cause severe and fatal acute decompensation. A person can also have:
- aortitis (infection of the aortic artery);
- cardiac abscess;
- heart rhythm disturbances.
In most cases, doctors are unable to detect endocarditis at an early stage: the symptoms of the disease begin to appear two weeks after infection. At the same time, the clinical picture of the disease is diverse – from erased signs to acute heart failure with the rapid destruction of the valves.
The first signs of infectious endocarditis of the subacute form can appear within 2-6 weeks from the moment of infection. This variant of the disease occurs with a malovirulent pathogen: streptococci, epidermal staphylococcus. In view of these features, the subacute form is characterized by a large variety and severity of symptoms of the pathological process.
Infectious endocarditis is characterized by the development of sepsis with primary localization of infection on the heart valves.
Of the features of acute infectious endocarditis, doctors distinguish:
- infectious-toxic syndrome with the development of shock;
- rapid destruction of heart valves with the formation of defects;
- heart failure;
- the formation of purulent metastases in various tissues and organs.
Chronic bacterial endocarditis develops as a result of a prolonged stay in the body of the focus of inflammation. The clinical picture of this form of pathology is very diverse and consists of the following symptoms:
- infectious-septic intoxication;
- heart failure;
- damage to visceral organs.
The central place is the defeat of the heart and blood vessels. However, the expanded clinic is not immediately observed, and the set of clinical symptoms is diverse:
Violation of the structure of the heart leads to disruption of its functioning, and the development of pathogenic microflora promotes the spread of bacteria with blood flow throughout the body. Due to this, complications of infectious endocarditis can occur from almost all organ systems.
The main complications of the disease:
- Heart failure. It occurs due to the destruction of the heart valves, which leads to their inability to function properly. The inflammatory-infectious process eventually spreads to the deeper layers of tissues (myocardium), and also causes the destruction of the aortic valve leaflet.
- Neurological complications. The cause is embolism of the cerebral vessels, which leads to a violation of trophic tissue and insufficient intake of oxygen to them. In the future, patients may experience ischemic or hemorrhagic stroke, meningitis, toxic damage to the meninges. In some cases, circulatory disorders lead to the appearance of aneurysms, rupture of which reduces the likelihood of a favorable outcome for the patient.
- Renal failure. It occurs when toxins enter the urinary system, which destroy its tissues. It may also develop due to the toxic effects of antibiotics or contrast agents, which are used for diagnosis.
- Rheumatic diseases. The systemic spread of infection leads to damage to the musculoskeletal system.
- Pathology of the spleen.
- Pathologies of the respiratory system – pneumonia, pulmonary hypertension, abscess.
A prolonged absence of obvious symptoms of the violation leads to a high incidence of complications. Among the main ones, it is worth noting the following:
- Heart failure. Inflammation of the mitral valve leads to insufficient ejection of blood. Against the background of the negative process, myocardial dysfunction develops, which provokes a heart attack or myocarditis.
- Acute renal failure – occurs in 30% of patients, the prognosis is poor.
- Rheumatic complications. Musculoskeletal symptoms, joint pain, myalgia, back pain are common with endocarditis of an infectious origin.
- Neurological pathology. 40% of patients diagnosed with infectious endocarditis develop. The cause of such deviations is embolism.
Clinical manifestations have a wide range and include:
- ischemic and hemorrhagic stroke;
- latent cerebral embolism;
- brain abscess, meningitis;
- toxic encephalopathy.
Endocarditis can lead to damage to the heart valves, impaired conduction and heart failure.
Neoplasms that occur with endocarditis can come off and move with blood flow throughout the body. This can lead to blockage of blood vessels and the death of organs.
- Heart failure;
- Myocardial infarction;
- Acute renal failure;
- Septic shock.
Disease in young patients
Infectious endocarditis in children is represented by an inflammatory lesion of the endocarditis of the heart. Such a pathological process has an infectious breed.
Often, the disease serves as a complication of a heart defect of a congenital or chronic form, and especially after surgery. Various viruses, fungi contribute to the formation of defect. Often the cause of the disease lies in defects in the immune system, a focus of chronic infection. In infectious endocarditis in young patients, mortality is very high.
A congenital and acquired form of the disease is distinguished. The main symptoms of childhood infectious endocarditis include:
- rapid weight loss;
- increased sweating;
- fever in the evening;
- pain in joints and muscles.
The disease can begin acutely and be accompanied by a rapid formation of symptoms. However, most often the first stage of the pathology proceeds slowly and imperceptibly. The duration of the process is sometimes delayed and difficult to treat.
Over time, infectious endocarditis becomes generalized. As a result, the lesion is applied to other organs. Infectious endocarditis in small patients can cause complications such as blood clots, resulting in blockage of the vessels of the internal organs and brain. Against the background of insufficient heart function, shortness of breath, pallor and blueness of the skin, swelling occur. Symptoms of the disease are so diverse that it is very difficult to immediately establish the disease.
- listening to the heart, during which gross noises can be detected;
- bacterial plasma cultures.
When the results of a full examination of the patient are on hand, you can go directly to your doctor. Try to pass all the tests as quickly as possible, as the time spent can then affect the state of your health and the effectiveness of the subsequent treatment.
Diagnosis of endocarditis
It is difficult to identify endocarditis in that the disease can begin in various ways. The main criteria are: fever with chills, bacteriological findings confirming infection and valve defects found on echocardiography (heart ultrasound).
An electrocardiogram (ECG) allows you to establish signs of ventricular proliferation and conduction disturbances, which can occur already in the early stages of endocarditis.
Blood tests can distinguish between different types of endocarditis from each other.
The symptomatology of endocarditis can be quite subtle and nonspecific. Endocarditis should be suspected in patients with fever of unknown origin with a heart murmur. Suspicion becomes very high if a history of valvulopathy or other heart defects is reported.
As soon as a suspicion of endocarditis is established, the diagnosis should be confirmed by ultrasound examination of the heart and blood culture.
Echocardiography allows you to visualize the heart chambers and measure the ejection fraction. In this case, it is important to detect the presence of bacterial vegetation and evaluate the residual function of the heart valves.
Blood culture is a study that consists of taking blood samples from a patient and placing them in a bacterial culture (at least 3 samples in 24 hours in accordance with febrile peaks). Within a week, an infectious agent responsible for bacteremia and, therefore, for endocarditis can be distinguished.
Diagnosis of the disease is carried out comprehensively. After a preliminary diagnosis, the doctor directs the patient to additional studies. Diagnosis begins with a history and assessment of complaints. It should be borne in mind that the clinical picture appears approximately 2 weeks after infection.
The patient can talk about the general manifestations of intoxication, as well as about the subjective sensations that appear due to heart failure. In this case, a specialist can notice peripheral manifestations – petechiae, spots, nodules, changes in joints.
During a physical examination, the doctor reveals pallor of the skin, weight loss, a change in the phalanges of the fingers. During the consultation, the specialist can conduct a test, the results of which reveal the degree of fragility of the capillaries. Percussion of the heart reveals the localization of the lesion, and auscultation – the presence of organ dysfunction.
After consulting a specialist, the patient must undergo laboratory tests. In a blood test, leukocytosis, anemia, and elevated ESR are usually detected. Bacteriological blood culture is also carried out to identify the pathogen.
Some patients have an increase in rheumatoid factor. If the urinary system is affected, protein and signs of inflammation can be detected in the urine. Instrumental diagnostics allows you to make a final diagnosis. A cardiogram plays a key role, but can be supplemented by MRI and other methods.
Dopplerography can also be prescribed to the patient to assess the condition of the vessels and circulatory system. Infectious endocarditis is often accompanied by thromboembolic complications. With the timely detection of such a pathology, it is possible in time to prevent a heart attack of the affected organs.
Diagnosis of endocarditis includes:
- Visual inspection, palpation, percussion, auscultation;
- General blood analysis;
- Blood chemistry;
- General urine analysis;
- Electrocardiography (ECG);
- Echocardiography (echocardiography);
- Ultrasound examination (ultrasound);
- Magnetic resonance therapy (MRI);
- Computed tomography (CT) scan.
Even if all the symptoms indicate infectious endocarditis, the diagnosis is made only after a comprehensive examination of the patient. It includes laboratory and instrumental research methods. Among those:
- Blood cultures – carried out before the start of antibiotic therapy.
- Serological studies – are prescribed for suspected following types of pathogen: Brucella, Histoplasma capsulatum, Cryptococcus neoformans, Legionella, Chlamydia.
- MRI (high sensitivity in determining strokes compared to CT).
- Radioisotope study.
- Multilayer CT (determines the available near-valve changes: shunts, abscesses, pseudo-aneurysms).
Treatment of infectious endocarditis includes a set of measures to eliminate the inflammatory process in the inner membrane of the human “motor”. Most often, antibacterial therapy and surgical intervention are involved in the process. If there is a formation of heart disease, then treatment should be aimed at correcting it. If infectious endocarditis is suspected, the patient should be hospitalized urgently.
When treating endocarditis with antibiotics, you need to discuss this issue with your doctor. Their purpose is taking into account the degree of sensitivity. The course of admission should be at least 4-6 weeks. As a rule, a specialist prescribes a complex of medications to a patient in order to achieve maximum effect. It could be:
- Ampicillin-Sulbactam with Gentamicin;
- Vancomycin and Ciprofloxacin.
In addition to antibiotic medications, treatment of infectious endocarditis involves medications that affect the immune system.
If there is a disease of a non-bacterial nature, then for the treatment of endocarditis, the specifics of the underlying ailment must be taken into account. When endocrine pathology is diagnosed, the patient must undergo hormone tests and be treated under the supervision of an endocrinologist. Endocarditis, which is the result of intoxication, can be treated by canceling the use of a certain type of toxin.
Surgical removal of the inflammatory process involves the removal of the affected area of the heart valve with further prosthetics. If there is such an opportunity, then the patient undergoes plastic surgery to maintain their own valves. After the rehabilitation period, the patient should be under the supervision of doctors.
Aortic valve prosthesis
The treatment of endocarditis, the tactics of therapy and the selection of drugs depends on the type of disease, its stage and etiology.
If you suspect the infectious nature of the disease, the patient is required to be hospitalized. This is due to the high mortality from IE complications. If the patient’s condition has not worsened in 1-2 weeks, he is discharged for treatment at home.
1. Drug treatment (conservative treatment); 2. Diet 3. Surgical treatment; 4. Prevention of complications of the disease.
Important! Before using drugs, be sure to consult your doctor!
Particular attention should be paid to the fact that the principles and medicines for infectious and rheumatic endocarditis are different.
Important! Before using folk remedies against endocarditis, be sure to consult your doctor!
In addition, it should be noted that many traditional healers offer folk remedies as auxiliary, while the main type of treatment remains – conservative therapy.
Celandine. Pour 200 ml of boiling water for 0,5 teaspoon of celandine dry grass, cover the glass with a lid and set it aside for 30 minutes to insist. Strain and drink it in several sets throughout the day. The course of treatment is 1 month. This tool helps prevent a relapse of the disease.
Lemon, garlic and honey. Make a mixture of 10 peeled lemons, 1 liter of honey and 10 heads of peeled and chopped garlic. After thoroughly mixing, set aside the infusion a week in a dark, cool place. You need to take the drug daily for 1 tbsp. tablespoons per day for 6 months.
St. John’s wort, motherwort and buckwheat. Collect from dried 60 g of St. John’s wort grass, 40 g of motherwort and 40 g of buckwheat flowers. Pour 1 liter of water 3 tbsp. tablespoons of the cooked collection, put it on fire, bring to a boil and simmer for about 1-2 minutes on low heat. After set aside the infusion to cool and insist, for about 1 hour. Strain the resulting broth and take 250 ml per day. This tool helps to remove the inflammatory process from the endocardium.
Rosemary, elderberry and arnica. Make a collection of 3 parts of rosemary, 2 parts of black elderberry flowers and 2 parts of arnica flowers. 1 tbsp. spoon the resulting mixture pour 300 ml of boiling water and set aside the means for cooling and insisting. When the product has cooled, strain it and drink it several times during the day.
The basic principles for the treatment of infectious endocarditis are as follows:
- The patient needs to be hospitalized even if a disease is suspected or only a preliminary diagnosis is available
- Antibacterial therapy involves the use of antimicrobial drugs in maximum doses. The duration of treatment for the disease is usually several weeks.
- Treatment must be supplemented with detoxification agents, vitamins, protein compounds
- Be sure to examine the blood to identify the pathogen and the right choice of drug for treatment. In this case, antibiotic therapy is usually started before the results of culture
Endocarditis is treated with antibiotics or, less commonly, surgically. Antibiotic therapy is carried out intravenously (after hospitalization) and lasts for 2-8 weeks to completely eliminate the infection. At the same time, all devices that may constitute the pathway of pathogenic microorganisms, especially venous catheters or foreign materials, must be removed.
Surgery is necessary if there is no adequate response to antibiotic therapy, or if the valves are inevitably damaged due to severe valve failure.
Surgical options can be expected depending on the case:
- sanitation of vegetation;
- valve correction;
- valve replacement.
How to treat endocarditis, which drugs to use – doctors determine based on the nature of the cause that triggered the disease. The basis of therapy is antibiotic treatment. The main condition for successful antibiotic therapy is its early start, before the onset of clinical signs.
The antibacterial treatment program itself is often supplemented by such surgical procedures as:
- removal of infected tissue;
- cleaning and subsequent drainage of paravalvular infection;
- reconstruction of a damaged valve;
- heart valve replacement;
- removal of the source of embolism.
As noted above, the basis of drug treatment is antibiotic therapy.
With identified enterococci:
- Amoxicillin 200 mg/kg per day for 4-6 doses of Gentamicin (3 mg/kg per day) for 2-6 weeks;
- Ampicillin at the rate of 200 mg/kg per day for 4-6 doses of Ceftriaxone 4 g/day in 2 doses. The course of treatment is 6 weeks;
- Vancomycin – 30 mg/kg per day for 2 doses for 6 weeks Gentamicin 3 mg/kg per day.
If strains resistant to β-lactam antibiotics are found:
- Daptomycin – 10 mg/kg per day Ampicillin 200 mg/kg per day for 4-6 doses for 8 weeks;
- Linezolid – 600 mg for 8 weeks;
- Quinupristine Dalphopristine – 7,5 mg/kg 3 times a day for 8 weeks.
Endocarditis treatment has two directions – medication and surgery. Surgical intervention is quite dangerous, but in cases where drug treatment does not give a result, heart failure may develop and the surgical method is the only way to save a patient’s life.
During treatment, constant monitoring of the level of microorganisms in the blood and the state of the heart is performed using ECG and echocardiography.
In subacute endocarditis, high-dose preparations of benzylpenicillin sodium salt or cephalosporins in combination with gentamicin are prescribed. Antibiotics are administered predominantly intravenously. In extreme cases, prosthetics of a damaged heart valve are used.
With the infectious type of endocarditis, antibiotic treatment is used.
In the treatment of endocarditis, they primarily pay attention to the therapy of the main pathology – rheumatism, sepsis, systemic lupus erythematosus. The technique of using antibacterial drugs has proven itself well. In most cases, they are used. Antibiotics are selected according to the result of blood cultures on the microflora in order to inflict an exact blow to the infection, while minimizing the toxic effect on the body.
As a rule, a patient is hospitalized in order to monitor his condition and administer antibiotics via an intravenous dropper. Imaging blood is constantly taken from the patient, according to the results of the analysis, progress in treatment will be clearly visible. Then you can return home and take antibiotics prescribed by your doctor yourself.
A significant effect is achieved by a combination of drugs, which complicates the selection procedure. The classic options are ampicillin and sulbactam, as well as vancomycin and ciprofloxacin.
70% of the success in the antibacterial treatment of endocarditis is taken by drugs that stimulate the immune system.
Endocarditis can cause serious damage to the heart. Surgical treatment of endocarditis is based on excision and removal of the affected area. About 20% of patients with endocarditis may need surgical treatment. Operations are recommended in cases:
- Symptoms and/or test results show the occurrence of heart failure (a serious condition in which the heart is unable to meet the needs of the body).
- For a long time, despite treatment with antibacterial and antifungal drugs, fever and fever are kept.
- The patient has an artificial heart valve.
Three main surgical procedures for treating endocarditis:
- repair of a damaged heart valve;
- replacement of damaged heart valves with prostheses;
- removal of any abscesses that may form in the heart muscle.
The operation is offered only to patients with a severe course of the disease. Unfortunately, even in the case of a successful operation, one in ten patients dies during or some time after the operation. If possible, their own valves are stored by plastic surgery. In cases where the valve is deformed too much – it must be changed to artificial.
A successful operation transfers a person to outpatient monitoring with a constant collection of tests and examinations. The next 6 months, a person undergoes a monthly examination – this is a very dangerous zone of infection recurrence. Further inspection must be carried out twice a year.
Treatment of endocarditis is based on the main goal – the need to completely restore or remove tissues that have undergone inflammatory processes.
Complications from the presented disease arise due to growths on the heart valves. They can disconnect and with the flow of blood affect other organs and systems. If they get stuck in a small vessel, this will cause an acute lack of blood supply, which will result in tissue death. You can also defeat the kidneys.
Prevention of endocarditis includes:
- Timely treatment of diseases, especially of an infectious nature, so that they do not become chronic;
- Compliance with preventive measures for acute respiratory viral infections, acute respiratory infections and influenza;
- Avoiding hypothermia of the body;
- Avoidance of stress; if necessary, change job;
- Try to eat foods enriched with vitamins and minerals;
- Use medications only after consulting your doctor.
If you do not want your body to pick up such a pathology, then you should know the main measures that can protect you from endocarditis. Prevention involves the following series of actions:
- When using drugs, it is urgently necessary to refuse them, since it is these people who are at greater risk of getting sick.
- Those who have artificial valves or chronic heart disease should always be under the supervision of a specialist.
- Constantly monitor the quality of processing of medical equipment and ask your doctor about the quality of sterilization.
Endocarditis can be affected by every person, both an adult and a child. The reason for this pathology lies in the defeat of the body by an infectious agent. The disease manifests itself with chills, fever and headaches. It is possible to cure this condition, but only under the condition of an integrated approach. If you delay with therapy, you can get a number of unpleasant and dangerous complications, which will subsequently be very difficult to treat.
Patients with a different risk of endocarditis should undergo antibiotic prophylaxis whenever they undergo any invasive procedure, which may include the penetration of pathogens into the blood circulation.
Patients most at risk:
- artificial heart valve;
- previous picture of endocarditis;
- Congenital heart defect;
- transplantation of a heart or other organs.
The most risky procedures:
- dental first;
- piercings or tattoos;
- associated with the respiratory tract;
- associated with the gastrointestinal tract;
- associated with the genitourinary tract;
- related musculoskeletal system (musculoskeletal system).
It is believed that antibiotic prophylaxis prescribed before risky procedures is an effective means of prevention for patients at high risk; from a general point of view, it is recommended:
- Treat oral hygiene, periodically undergo scaling and dental control (at the dentist).
- Avoid piercing or tattooing.
- Report any unexplained episode of fever to your doctor.
- Remind any doctor before the procedures that you are at risk.
Be sure to remember that in the simplest case, the first-choice antibiotic in the prevention of endocarditis is Amoxicillin, which must be taken 30-60 minutes before the dental procedure.
Prevention is to prevent infection, good oral hygiene, timely treatment of congenital heart defects, and drug addiction. In some cases, cardiologists may prescribe antibiotic prophylaxis for specific groups of patients.
Early prevention of endocarditis is based on non-specific methods of preventing the disease.
Key measures include the following:
- Hygiene of the oral cavity and skin: examination by the dentist 2 times a year for people with a history of history, at least 1 time – for the rest.
- Disinfection of wounds.
- Exclusion of chronic carriage of bacteria on the skin and in the urinary tract.
- Early use of antibiotics in case of detection of a focus of bacterial infection.
- Strict measures for the prevention of infection during surgery.
- Limiting the use of intravenous catheters, invasive procedures, compliance with patient care rules with central catheters.
Prevention of endocarditis involves monitoring your health. It is very important to treat all infectious diseases in a timely manner and prevent their chronic course.
Never be shy about telling your healthcare provider if you notice that the instrument is being handled carelessly. You should be interested in the sterility of the instruments used, especially when visiting a dentist.
People with artificial heart valves and diseases of the heart muscle should be systematically observed by a doctor, since this category of patients is at risk.