The term "rheumatic endocarditis" refers to a pathological process characterized by inflammation of the inner lining of the heart. As a result, the myocardial chambers become inelastic and lose their smoothness. The disease can occur due to many reasons. However, doctors believe that rheumatism is the main trigger for the development of the disease. At the same time, tendons, connective tissue of valves and parietal endocardium are involved in the inflammatory process.
Pathogenesis
The disease is characterized by the formation of blood clots and an increase in the area of granulation tissue. In rheumatic endocarditis, damage to the aortic and mitral valves is more common. Sometimes they are both involved in the pathological process. In isolated cases, a lesion of the tricuspid valve is detected.
The mechanism of disease development is as follows:
- Under the influence of any unfavorable factor in the myocardium, the development of the inflammatory process is triggered. Then hespreads to nearby tissues via the anulus fibrosus.
- In the valve, collagen fibers swell, inflammation of a proliferative nature develops. Against the background of this process, diffuse infiltrates are formed, that is, foci filled with cellular elements mixed with lymph and liquid connective tissue.
- The surface of the valve is undergoing changes. It forms fibrin and blood clots. As a rule, this occurs in those areas that are prone to mechanical damage. In most cases, we are talking about the area of \u200b\u200bclosure of the valves. With damage to the mitral valve, the focus of pathology is formed on the side that faces directly to the atrial cavity.
- Growths and scars form on the damaged tissue. Due to this, the valves are deformed.
The most common outcome of rheumatic endocarditis is heart disease. But this is not the most dangerous complication. In this regard, it is necessary to consult a doctor at the first warning signs.
Etiology
As mentioned above, doctors consider rheumatism to be the main cause of the development of pathology. At the same time, against the background of the course of the latter in the patient's body, an active vital activity of streptococcal infection is often detected. If the body is exposed to the negative effects of a pathogen for a long time, re-infection occurs. Due to this, the process of destruction of connective tissue is launched, the permeability of blood vessels increases. In addition, there is a violation of the neurohumoralreactions.
Other causes of rheumatic endocarditis:
- Diffuse connective tissue pathologies.
- Recently performed surgical intervention in the organs of the cardiovascular system, the outcome of which was unsuccessful. As a rule, rheumatic endocarditis in this case is the result of a medical error.
- Allergic reactions. Most often, the provoking factor is the uncontrolled use of medications.
- Intoxication process in the body.
- Bacterial diseases.
The most harmless cause doctors consider intolerance to a particular drug. This is due to the fact that this form of the disease practically does not give complications. In the future, the patient only needs to avoid taking the medication that is an allergen.
Types of disease
Physicians classify rheumatic endocarditis according to several criteria. There are 4 types of disease:
- Diffuse. In this case, the structure of the connective tissue changes on the entire surface of the valve. Quite often from a left ventricle granulomas of the small size are found. The valve leaflets thicken significantly, which is why the heart ceases to function normally. The diffuse type of pathology is characterized by simultaneous tissue damage in several areas at once. With timely treatment, the prognosis is usually favorable.
- Sharp warty. In this case, detachment of the upper layer of the endocardium occurs. Fibrin accumulates in the focus of pathology and depositsthrombotic masses. This, in turn, leads to the formation of warts, which outwardly look like tubercles of gray or light brown color. Often they combine and form large pathological foci. Warts do not contain pathogens, but the possibility of secondary infection is possible.
- Return warty. The changes are the same as above. The difference from acute warty endocarditis is only in the course of pathology. With this type of disease, formations are formed periodically. At the stage of remission, it is almost impossible to identify them.
- Fibroplastic. Changes in this type of disease are irreversible. In this regard, for patients with endocarditis, the doctor may recommend only surgery.
Regardless of the type of disease, treatment of the disease cannot be delayed. This is due to the fact that changes in the heart pose a threat not only to he alth, but also to human life.
Clinical manifestations
The symptoms of rheumatic endocarditis are usually non-specific. All forms of the disease have the same clinical manifestations. At the stage of the survey, the doctor can only find out the nature of the pathology (infectious or not).
Rheumatic endocarditis symptoms:
- Shortness of breath. At the initial stage of the development of the disease, it appears only after high-intensity physical exertion. Its duration is approximately 2 minutes. Over time, its intensity increases, it begins to disturb even indormant.
- Painful sensations in the region of the heart. With endocarditis, they do not always occur. But in the late stage, pain in any case appears against the background of physical exertion and prolonged exposure to stress.
- Rapid heartbeat. Tachycardia is characteristic of absolutely any form of the disease. At the same time, its occurrence is not associated with either physical activity or any other factors.
- Formation of drum fingers. This symptom appears in the later stages of the course of the disease. The fingers become very narrow, and the last phalanx, on the contrary, greatly expands.
- Changing the shape of nails. The plates become wider. Then they take on a rounded shape. The central part of the nails rises, as if forming a dome.
- Pale skin. It is typical for any stage of the disease. Against the background of serious damage to the valves, blueness of the fingers and the tip of the nose is often observed.
- Increased degree of fatigue. Like shortness of breath, at the initial stage of development, it appears only after intense physical exertion. Over time, fatigue increases, the patient quickly gets tired even after performing the usual daily activities.
The above clinical manifestations do not allow the doctor to make an accurate diagnosis. He can only assume the presence of the disease and its nature. The presence of the following symptoms indicates an infectious pathology: chills, fever, excessive sweating, skin rashes, migraine, muscle pain.
In childrenrheumatic endocarditis manifests itself in the same way as in adults. Most often, the disease is detected during a routine examination by a pediatrician. Already a month after the onset of the development of the pathological process in the heart, murmurs can be heard.
Activity stages
The nature of the disease directly affects the intensity of clinical manifestations. Doctors distinguish three stages of the activity of the pathological process:
- Minimum. Characteristic of prolonged rheumatic endocarditis. Symptoms are mild.
- Expressed. Characteristic of constantly recurrent endocarditis.
- Max. Accompanied by severe symptoms. At the same time, signs of damage to other body systems appear.
The difficulty lies in the fact that in the early stages the disease rarely manifests itself. As a result, patients go to the doctor already at the stage of complications.
Diagnosis
When the first alarming symptoms appear, you need to make an appointment with a cardiologist. The specialist will conduct an examination and take an anamnesis, after which he will issue a referral for an examination.
Required diagnostic measures:
- General and biochemical blood tests.
- Research for streptococcal antibody titers.
- Jar sample.
- ECG.
- X-ray examination.
Based on the results of the diagnosis, the doctor makes the most effective treatment regimen.
Treatment
Whendetection of rheumatic endocarditis, the patient is hospitalized. He must be in the hospital for the entire period of treatment.
Initially, the hospital carries out a test for the sensitivity of the pathogen to antibiotics. The need for a test is due to the fact that the main stage in the treatment of rheumatic endocarditis is antibiotic therapy. In most cases, doctors prescribe Penicillin to patients. It must be administered intramuscularly 4 times a day. Often, the drug is combined with Sigmamycin and Streptomycin.
After the patient's condition stabilizes, the dosage is gradually reduced, after which the administration of antibiotics is completely canceled. After 1.5 months, the course of treatment is repeated.
Therapy is always supplemented with iron supplements and cardiac glycosides.
Complications
The outcome of rheumatic endocarditis directly depends on the timely visit to the doctor. But even with a quick recovery, negative consequences are often diagnosed.
The most common complications of rheumatic endocarditis:
- Chronic heart failure. The muscle stops pumping the required amount of liquid connective tissue.
- Thromboembolism. Against the background of blockage of the artery, death most often occurs.
- Persistent bacteremia. This, in turn, can also cause all sorts of complications.
To eliminate the negative consequences, most often resort to surgical intervention.
Forecast
Even in the absence of complications, rheumatic endocarditis leads to the fact that the patient becomes disabled. 10% of patients relapse after a few months.
According to statistics, the disease often leads to death. The mortality rate is up to 40%. With timely access to a doctor, the prognosis is more favorable.
Prevention
There are no specific measures to prevent the development of the disease. It is important to strengthen the immune system, regularly expose the body to moderate physical activity and follow the principles of proper nutrition. In addition, it is important to treat identified diseases in a timely manner, especially rheumatism.
In closing
Under the influence of various negative factors, inflammation of the inner lining of the heart can occur. In this case, it is customary to talk about the development of rheumatic endocarditis. The disease has several forms, but at the initial stages of development, it practically does not manifest itself in any way. Due to this, patients most often go to the doctor at the stage of development of complications.
