Infective endocarditis is a lesion of the tissue of the valvular apparatus of the heart and endothelium by various pathogenic and opportunistic pathogens. Most often, this pathology affects the heart valves. Today, this disease is more common on the background of degenerative changes in the valves, but in some cases it can be caused by rheumatism. More often the disease affects the mitral and aortic valves, and only in a small number of patients the right parts of the organ can be affected. They are often affected in drug addicts who inject drugs, or in patients as a result of the use of venous catheters.
The treatment of infective endocarditis requires the right approach, so it is important to confirm the diagnosis as soon as possible and follow all the doctor's recommendations.
Reasons
Microorganisms can cause disease. Today, experts identify more than 100 pathogens, these include:
- streptococcus,
- staph,
- enterococcus,
- mushrooms and others.
There are also intracardiac risk factors:
- congenital and acquired heart defects;
- presence of artificial valves;
- sagging valve blades;
- anomalies and structural features of the heart.
Extracardiac infections can also be causes of infective endocarditis:
- use of invasive examination techniques when penetration into the body is necessary to make an accurate diagnosis;
- injection drug addiction;
- secondary immunodeficiency, when the body's defenses are greatly reduced, and this happens if the patient does not control the intake of antibiotics or is often affected by unfavorable ecology;
- operations that affect the mucous membrane of the respiratory tract, intestines and stomach, urinary tract, in the presence of infections in these organs.
Infective endocarditis: classification
By origin, the disease is divided into primary and secondary forms. Primary most often occurs in septic conditions against the background of an unchanged structure of the heart valves. If secondary infective endocarditis develops, the valve and vessels already have changes due to congenital malformations, rheumatism, syphilis, and a history of surgery.
According to the clinical course, the following forms are distinguished:
- Acute lasts for two months, develops as if in the body an acute septic condition, after severe injuries or medical manipulations on the vessels, heart cavities: nosocomial angiogenic sepsis. It is characterized by a pathogenic microorganism, severe septicsymptoms.
- Subacute lasts about two months, develops if the treatment of acute infective endocarditis was not correctly selected or the doctor's recommendations were not followed by the patient.
- Long.
In people with drug addiction, the clinical features of the disease are young age, rapid progression of ventricular failure on the right side, general intoxication, lung damage.
In elderly people, the disease may be due to the presence of chronic pathology of the digestive system, foci of infection, damage to the heart valves.
Distinguish between active and inactive form. According to the degree of damage, the disease proceeds with minimal damage to the leaflets of the heart valves or with a lesion that goes beyond them.
There are several main forms of infective endocarditis:
- infectious-toxic - with it, the patient has bacteremia, adhesion of the microorganism to the altered endocardium, the formation of microbial vegetations;
- infectious-allergic, also often called immuno-inflammatory by doctors, it is characterized by clinical signs of damage to internal organs: hepatitis, myocarditis, nephritis and others;
- dystrophic develops at the moment when the septic process or heart failure begins to progress.
The dystrophic form is characterized by the development of severe and irreversible lesions of internal organs. In most advanced cases, patients have toxic myocardial degeneration withnumerous foci of necrosis. The myocardium is affected in more than 90% of patients after prolonged infective endocarditis.
What are the symptoms of endocarditis?
Most often, the symptoms of endocarditis appear after microorganisms enter the bloodstream. Depending on how many bacteria there are, how the body reacts to them, what special reactions a person has to an infection, the disease may or may not be active. This means that the symptoms of infective endocarditis may be pronounced or they may not be at all.
Also, the disease can be complicated or uncomplicated. In the second case, the course of the disease does not cause a person any problems, but a complicated form can spread the infection to nearby organs. The body in endocarditis may respond to infection with the following symptoms:
- high body temperature;
- quick fatigue and fatigue;
- chill feeling;
- weakness all over the body;
- joint and muscle pain;
- excessive sweating, especially pronounced in the evening;
- swelling, most often in the lower extremities, in advanced forms can spread to the abdomen;
- malaise;
- shortness of breath;
- In rare cases, there are skin disorders.
To confirm the presence of infection in the human body, it is necessary to determine which of the bacteria "walks" through the bloodstream. Additionally, the patient may be forced to seek help if there are manifestations of anemia in the urine.there is blood, the level of leukocytes is above normal, a heart murmur.
After the first symptoms of infective endocarditis appear, you should definitely consult a doctor, undergo an examination and start treatment in a timely manner.
Diagnostic methods
To accurately diagnose "infective endocarditis", you need to conduct a series of studies that will help identify the manifestations of the pathological process in the body. In typical cases, diagnosis is based on the following signs:
- presence of fever;
- defects in the valves, manifested as myocardial murmurs;
- thromboembolic complications;
- positive for bacteria.
If you make an ECG, then you can see manifestations of left ventricular hypertrophy on it, if an inflammatory process of the aortic or mitral valve is going on in the body. But right ventricular hypertrophy is observed when the tricuspid valve or pulmonary artery is affected.
Possible and such phenomena as conduction disturbances, atrial and ventricular premature beats, in rare cases, atrial fibrillation or flutter can be detected. An ECG helps to identify the disease at an early stage, which in the future gives a chance to successfully undergo treatment and avoid serious complications. You can check the work of the heart if you use a cardiovisor for diagnostics, which will make it possible to detect even minimal deviations in the work of the heart muscles.
Echocardiography is recommended for all patients withwho are suspected of having infective endocarditis. Diagnostics will help to objectively assess the condition of the valves, reveal calcification, rupture of the valve leaflets or chords, and distinguish between an abscess of the valve ring. Often this technique is used to clarify the nature of the heart disease, to determine the need for urgent surgical intervention, when valve insufficiency develops acutely.
Blood tests are considered informative:
- general;
- biochemical;
- immunological.
General analysis may indicate anemia, a shift in the leukocyte formula to the left, but the most significant sign is a high level of ESR. Biochemistry reveals the presence of C-reactive protein, a high amount of fibrinogen, a low amount of albumin, an increase in the fraction of γ-globulins. Immunology will make it possible to detect rheumatoid factor, high levels of complement components.
It is also recommended to undergo blood cultures for sterility. But here it is very important to take blood correctly, the study can be carried out several times in order to obtain more reliable data as a result.
In order to increase the effectiveness of treatment, it is important not only to establish the diagnosis, but also the form of the disease.
How the disease manifests itself in childhood
Infective endocarditis in children is very common. Symptoms of the manifestation of the disease can be:
- acute toxicosis;
- endocardial inflammation;
- blockage of blood vessels by blood clots,which, moreover, can break away from the myocardium affected by the disease.
In children, primary inflammation affects the aortic and mitral valves, while secondary inflammation affects the inner lining of the heart. Symptoms of the course of the disease are similar to those of an adult, but negative changes develop much faster, which leads to more severe damage to internal organs.
As a diagnosis, blood, urine, ECG and seeding of the pathogen are used.
High doses of "Penicillin" in combination with "Gentamicin" are recommended as a treatment. But you need to remember that the doctor and each individual patient should calculate the dose of each medicine, depending on his age and body weight.
In the immuno-inflammatory phase, additionally taken: "Aspirin", "Ibufen", "Diclofenac" and other anti-inflammatory drugs.
For children, the prevention of infective endocarditis is very important, in which the rehabilitation of chronic foci of infection is used: tonsillitis, caries, sinusitis and others. Antibacterial therapy also gives a good effect, especially in cases where the disease is accompanied by high fever.
If no action is taken, the complications will be much more serious than they might seem.
Complications
One of the most serious complications of infective endocarditis can be considered an embolism - a detachment of a section of an overgrown valve, a blood clot and its further circulation through the arteries. Emboluswill stop at the place where its size corresponds to the diameter of the artery. If the detachment of the valve particle occurred in the left side of the heart, then embolization quickly develops in the vessels of the large circle, in which case the intestines, spleen or kidney may suffer. In them, the death of individual sections occurs, or, in simple words, a heart attack.
If a blood clot breaks off on the right side, then the vessels of the small circle - the pulmonary artery, are blocked, which means that a lung infarction develops. Other complications can also occur due to endocarditis:
- heart failure;
- formation of acquired heart disease;
- myocarditis;
- pericarditis;
- kidney damage;
- spleen lesion;
- vascular damage;
- faults in the nervous system.
That is why it is important to urgently start treatment and follow all medical recommendations. Infective endocarditis can be fatal.
Therapeutic Methods
First of all, if a patient has endocarditis, he needs to reconsider his diet, reduce s alt intake. The treatment program consists of the following items:
- compliance with the regime;
- diet food;
- antibacterial treatment;
- immunomodulatory therapy;
- detoxification treatment;
- glucocorticoids;
- symptomatic therapy;
- surgery.
After an accurate diagnosis is made, the patient must be admitted to the medicalinstitution.
With regard to nutrition, after admission to the hospital, the patient is recommended to adhere to diet number 10, which is characterized by a strict restriction of s alt - no more than 5 g per day. In the future, when inflammation indicators and kidney function are normalized, you can include familiar dishes and more fresh vegetables and fruits in your food.
Antibacterial therapy is the mainstay of treatment for infective endocarditis. Reception of antibacterial agents should be started immediately after confirmation of the diagnosis. Antibiotics are used in large doses, which are injected into the body intravenously. The course of therapy can be long - from a month to three.
The choice of drug and dose are selected in accordance with which of the pathogens was identified, and what is its sensitivity to antibiotics. Patients are recommended penicillins, aminoglycosides, cephalosporins, but in most cases they combine a couple of drugs at once.
Most antibiotics are excreted via the kidneys and metabolized in the liver, so the dosage should be adjusted depending on how affected these organs are in a particular patient.
If the antibiotic is chosen correctly, then already 10 days after the start of treatment, a positive effect is noticeable. Some patients may experience resistance to antibiotic treatment, and this may be due to various reasons:
- late therapeutic measures undertaken;
- there are several types of pathogens in the body at once;
- useinsufficient dose of the drug;
- immunodeficiency;
- development of the disease in old age with rapid generation of the disease;
- Multiple valve failure;
- prosthetic valve endocarditis;
- development of the disease in people on hemodialysis or using drugs.
In order for the treatment to have a positive effect, it is urgent to revise the scheme of therapeutic measures.
The waste products of microorganisms and toxins suppress the immune system. Antibiotics, which are taken for a long period of time in infective endocarditis of the heart, also lead to a similar effect. Therefore, you need to take all measures to support immunity:
- recommended to take thymus preparations, which have an immunotropic effect, for a course of at least 10 injections;
- about 4 plasmapheresis and hemosorption procedures;
- up to 6 infusions of antistaphylococcal or antipseudomonal plasma;
- normal human immunoglobulin up to 10 injections per course;
- blood irradiation with ultraviolet light up to 7 procedures;
- laser irradiation of intravascular blood − 10 sessions.
To remove toxins from the body, "Hemodez", "Reopoliglyukin", "Glucose solution 5%", "Sodium chloride" solution 9% and others are injected intravenously.
The etiology of infective endocarditis is such that immune disorders may come to the fore, in which case glucocorticoid therapy may be required. It has been discussed for many yearsthe expediency of its appointment, but there are several main indications for use:
- toxic shock;
- severe immune complex syndromes;
- allergic to antibiotic;
- secondary antibiotic resistance.
Symptomatic treatment is also recommended:
- if your joints hurt, then you can't do without non-steroidal anti-inflammatory drugs;
- if circulatory failure develops, diuretics, peripheral vasodilators and cardiac glycosides are recommended, but the latter are taken with extreme caution;
- with the development of thromboembolism, anticoagulants, antiplatelet agents and thrombolytics are prescribed;
- anemia will require iron supplements;
- antihypertensives recommended to lower blood pressure;
- definitely need multivitamin therapy;
- dysbacteriosis therapy is also needed.
In severe advanced cases, surgery may be required.
Surgery for endocarditis
In some cases, surgery on affected valves is indispensable. The main goal of surgical intervention is the elimination of foci of infection that affected the valves. Affected valves in infectious endometritis are excised and replaced with a prosthesis.
Operation can be shown when available:
- rapid progression of heart failure due to severe damage to valve elements;
- complete resistance to antibiotic therapy;
- valvular abscessesring or infarction;
- thrombosis in vital organs;
- prosthetic valve endocarditis;
- disease recurrence;
- large mobile growths on the valves.
Timely operation reduces mortality. But it can only be done if endocarditis is an independent pathology, in other cases it makes no sense.
Forecast
Endocarditis is a serious illness with a poor prognosis. In patients without immune deficiency, malformation and heart disease, the disease is treatable, especially if therapy was started in the early stages. If a person falls ill with endocarditis, and in addition to it, he has chronic heart disease or the immune system is sufficiently suppressed, then life-threatening complications for the patient may eventually develop.
Prognosis may worsen significantly if symptoms begin to appear after admission to the hospital, during the first three days. If gram-negative microflora, Staphylococcus aureus, Cochiella and Brucella insensitive to antibiotics, fungal flora were sown from the patient's blood.
When the right side of the heart is affected, the prognosis is more favorable. Rheumatoid endocarditis is also not life-threatening.
Preventive methods
Prevention consists of the following activities:
- you need to stick to physical activity and proper nutrition in order to undergo fewer examinations and use invasive methods in treatment;
- it is important to timely identify foci of infection: treat teeth, wash tonsils with tonsillitis, ensure outflow from the sinuses with sinusitis;
- if you still need treatment, then consult a specialist, and not use traditional methods at home;
- if life and work involve frequent injury, then you need to maintain immunity;
- if an injury is received, then it is necessary to treat the wound with high quality using antiseptics;
- if the doctor recommends taking antibiotics for some reason, then this must be done and be sure to follow all the recommendations.
Symptoms and criteria for infective endocarditis, used in the diagnosis of this disease, allow you to quickly identify the disease. Only for this you need to urgently consult a doctor at the first sign of illness. Only timely diagnosis and treatment will help to avoid not just consequences, but also death.
