Endocarditis is an inflammation of the inner shell of the heart, often with damage to the valve apparatus and a layer of cells lining the surface of adjacent vessels.
Often the pathology of the endocardium is not an independent disease, but develops as a consequence of other diseases. It can occur at any age, about 128 species of microorganisms are considered potential pathogens.
According to etiological and clinical-morphological features:
- Infectious (bacterial, septic) acute;
- Subacute or chronic (protracted);
- Non-infectious thromboendocarditis;
- Parietal fibroplastic eosinophilic (endocarditis of Leffler).
The danger is that the average term of diagnosis is at least 2-3 months from the first complaints and calls to the doctor, and about 85% of patients go to the hospital in general with the wrong diagnosis.
Symptoms of endocarditis
Endocarditis may occur suddenly or persistently asymptomatic; Have an acute or protracted course; Differ in a significant variety of manifestations, which makes diagnosis difficult.
The clinical picture usually develops within 2 weeks of infection. An important symptom is fever accompanied by chills and sweating. The temperature response is variable: from high for several months to a slight increase in temperature for several days, followed by normalization.
When the clinical picture is expanded, the following symptoms are noted:
- Severe intoxication: weakness, anorexia, headache, arthralgia;
- Changes in the skin: pale yellowish skin color, small-dot hemorrhages on the skin and mucous membranes, spots on the palms, feet, trunk;
- Changes in terminal phalanges and nails;
- Arthritis of large joints of upper and lower extremities;
- Damage to the aortic or mitral valve;
- Thromboembolism of large arteries with the development of infarctions of the corresponding organs;
- Signs of dry or exudative pericarditis;
- Enlarged lymph nodes;
- Kidney damage (focal nephritis, kidney infarction);
- Defeat of the central nervous system: meningoencephalitis, thromboembolism of the brain vessels, psychosis;
- Progressive heart failure.
The course and outcome of the disease, as well as the clinical picture in each case, depend on the state of the body's immune system and the degree of expression of the process.
Diagnosis of endocarditis
To establish the correct diagnosis, it is necessary to take into account the whole complex of manifestations of the pathological process. In typical cases, the diagnosis of endocarditis is based on the following symptoms: the presence of fever with chills, valvular defects with the appearance of myocardial murmur, thromboembolic complications and positive results of bacteriological examination.
On the electrocardiogram (ECG), there are signs of left ventricular hypertrophy (with an inflammation of the aortic or mitral valve) or right (lesion of the tricuspid or pulmonary artery valve). Possible conduction abnormalities, atrial and ventricular extrasystole, sometimes detect fibrillation or atrial flutter. Carrying out the ECG study allows you to determine the presence of the disease in the early stages, which becomes the determining factor for subsequent successful treatment. You can conduct a survey of your heart using a cardiovisor device that will detect minimal deviations in the functioning of the heart muscle.
Echocardiography (EchoCG) is recommended for all patients with suspected infectious endocarditis. The method allows you to objectively assess the condition of the valvular apparatus, promptly detect calcification, rupture of the valve flap or chords, abscess of the valve ring. Often EchoCG is used to clarify the nature of heart disease, as well as determine the need for urgent surgical treatment, when acute aortic or mitral valve deficiency develops.
Sufficiently informative are blood tests: general, biochemical and immunological. The general can show anemia and shift of the leukocyte formula to the left, the most significant sign is an increase in ESR. Biochemical analysis reveals the presence of C-reactive protein, an increase in the amount of fibrinogen, a decrease in albumins, an increase in the γ-globulin fraction. Immunological will help to detect the rheumatoid factor, the increased level of the components of the compliment.
There are also blood cultures for sterility - one of the most important stages in the suspected infectious endocarditis. The technique of blood sampling is important here, a similar analysis is repeated two to three times, so that the diagnosis was reliable the results should be the same. When the diagnosis of "endocarditis" is established, it is important to correctly identify the form of the disease, in order to increase the effectiveness of treatment.
Treatment of endocarditis
Treatment of endocarditis is often difficult, the inability to quickly establish a diagnosis. In addition, pathology can be "masked" for other syndromes. It is possible to single out the main directions used in the treatment of patients:
Used bactericidal drugs in high doses, with intravenous drip. Often, the use of a single medicine is ineffective, then combined medicines are used. Depending on the causative agent of the disease use: benzylpenicillin, gentamicin or amikatsin intramuscularly (infection with green streptococcus); Semi-synthetic penicillins in combination with cephalosporins or aminoglycosides (with staphylococcal endocarditis); With intolerance to penicillins macrolides can be administered; Vancomycin and fluoroquinolones are highly effective; Treatment with an antifungal antibiotic amphotericin. An indispensable condition is continuity and duration of treatment.
Passive immunization is used to neutralize microbial toxins circulating in the bloodstream with ready-made antitoxic sera. The most effective is hyperimmune plasma and human immunoglobulin, which is administered intravenously daily for 3-5 days.
The surgical method involves the mechanical removal of intracardiac foci of infection and affected valve structures, followed by the reconstruction and implantation of an artificial mechanical or biological prosthesis. It is realized in case of ineffectiveness of conservative treatment, developing heart failure, myocardial abscess, arterial thromboembolism, fungal endocarditis and other unfavorable outcomes of therapy.