Endocarditis - Causes, symptoms and treatment. MF.

Endocarditis is an inflammation of the inner shell of the heart( endocardium).The heart is a muscular organ, the main function of which is to ensure blood circulation. This organ consists of four chambers: the atrium of the left and right and right and left ventricles, separated by walls. The heart wall in its structure has three layers, each of which provides a certain function. The pericardium or the outer wall of the heart prevents excessive expansion of the heart cavities during its relaxation. The myocardium or the muscle itself provides the pumping function of the heart, which promotes blood circulation. The endocardium or inner membrane lining the chamber of the heart and ensures the smoothness and elasticity of the inner chambers of the heart. The main part of the endocardium is a connective tissue consisting of elastic and collagen fibers.

Heart wall structure

Very often endocarditis does not act as an independent disease but manifests itself as a consequence of the underlying disease.

Causes of endocarditis.

Depending on the cause of endocarditis, two independent groups are isolated: primary endocarditis and secondary endocarditis.

Vegetations that form on heart valves

Normal and damaged

valve Primary endocarditis is an initially inflammatory endocardial disease that can be caused by a different microbiological flora. Most infectious endocarditis causes streptococcus. The same cause can be gonococcus causing syphilis, meningococcus, E. coli, mycobacterium tuberculosis, yeast fungi and viruses. The inflammatory process, which is caused by these pathogenic microorganisms, is accompanied by the formation of vegetations( inflammatory proliferation of connective tissue in response to the inflammatory process), which are most often localized on the valves of the heart. These vegetation can be small and large, they tend to fragment and flow into various organs with blood flow. To the development of infective endocarditis predispose medical procedures, surgical or traumatic damage to the skin or mucous membranes. When a tooth is removed, a transient bacterial infection, more often streptococcal is recorded in 18-85% of cases. Removal of the tonsils, surgery in the nose is accompanied by a streptococcal infection. Recently, the incidence of infective endocarditis in injecting drug users has increased, since injections are the entrance gate through which the pathogen enters the bloodstream. As a special form of endocarditis, most secondary forms are isolated - endocarditis of prosthetic valves, endocarditis developing in patients with chronic kidney disease who are on program hemodialysis, with venous catheter infection during prolonged exposure in conditions of resuscitation, endocarditis of drug 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 known to the end, it is established that connective tissue is the target on which immune complexes are formed, formed as a result of cross-reacting and cascading mechanisms of the inflammatory reaction. Endocarditis is caused by systemic infections such as syphilis and tuberculosis, which are based on a pronounced inflammatory reaction, which results in long-term effects in the form of endocarditis. The medicinal lesions of the endocardium in the vast majority of cases remain not fully specified, although the development of some of them is explained by hypersensitivity reactions. It should be specially emphasized that these reactions are more often provoked by certain drugs, in particular antibiotics, immunosuppressors and hormones. The effect of ethanol on the heart is due to direct toxic effects on cardiomyocytes. A wide range of kidney disease, endocrine system and liver can cause various complications from the heart. Symptoms of endocarditis.

The variety of symptoms that can occur with endocarditis will depend more on the cause that caused this pathology, we will consider the most common symptoms. Fever is one of the first messengers of endocarditis. It is usually of the wrong type, i.e.then a rise, then a drop in temperature, occurs often without any external cause and continues day by day. When infectious processes, such as syphilis or tuberculosis, fever may not be, or body temperature is not higher than 37.5 degrees. Usually, along with a fever, there is a feeling of chill - from the cold to the sensation of cold, the creepy on the back.

The next group of symptoms of endocarditis are skin manifestations. It can be characteristic of patients with skin color "coffee with milk", sometimes the skin tone is pale or earthy. Also rarely, usually in long-term untreated patients, there is a symptom of "drum sticks" and "watch glasses" - this is the thickening of the terminal phalanges of fingers and nails. On the skin, small subcutaneous hemorrhages in the axillary region, in the inguinal folds, on the hips and abdomen can be detected. On the transitional fold of the conjunctiva, there may be spot hemorrhages. At present, this is a rare enough symptom, but it is often very important, as it can be suspected of the disease and its complications. In the region of the palmar surface, dense reddish-purple, painful to the touch nodules are found on the soles.

To a greater extent, infectious endocarditis is characterized by joint damage. Most often, this acute non-symmetrical lesion of the joints of the hands and small joints of the feet. Significantly less affected large joints - knee, elbow.

To peripheral symptoms of the disease also include weight loss, which sometimes develops very quickly( an example is described where the patient lost 18 kg in two weeks).Symptoms begin to increase with improper and ineffective treatment: there is shortness of breath during physical exertion. At first this does not interfere with the life and work of the patient, but over time, a person begins to feel that he increasingly has to take breaks in work and rest, which to a large extent reduces his performance. There are interruptions in the work of the heart, a person begins to sense and hear pathological noises. Due to the violation of blood circulation, there is a periodic headache, which subsides in a horizontal position.

Diagnostic measures.

Diagnosis of endocarditis is difficult due to the variety of the onset of the disease itself, the variety of damage to the heart tissue itself and non-cardiac manifestations. During a conversation with your doctor, he may ask you if you are at risk( people who take drugs, people who are often injected, health workers, people with chronic infection).Characteristic of the development of this disease after suffering angina or other respiratory infections. Be sure to inform your doctor if you have recently undergone any surgical procedures. Upon examination, the doctor may find you have an enlarged spleen and liver, pathological noises in the heart area due to improper operation of the valvular apparatus. Isolated systolic( upper) blood pressure may increase. Blood tests will show your doctor the level of blood coagulation. Part of the blood taken must be sown to special nutrient media to identify the causative agent of endocarditis. Ultrasound imaging methods will help to establish the degree, and sometimes the cause of non-infective endocarditis. ECG recording and chest X-ray can help eliminate other diseases such as intercostal neuralgia or pneumonia. If any changes from other organs are revealed, consultation of such specialists as cardiac surgeon, nephrologist, oculist and bacteriologist will be required.

With this pathology, one should not engage in self-medication with folk methods, this can lead to a tragic outcome. When there is shortness of breath, severe temperature which is not confused with drugs, it is necessary to immediately contact a physician or cardiologist. The probability of infective endocarditis should always be considered when conducting a differential diagnosis with prolonged fever.

Treatment of infectious and non-infective endocarditis.

The main goal of endocarditis treatment is to suppress antibacterial therapy or surgically remove inflamed tissues. When forming a heart defect, adjust it. Treatment of non-cardiac complications. If suspected of infectious endocarditis, the patient should immediately be hospitalized for examination and treatment. Antibiotics are prescribed only by a doctor and taking into account the degree of sensitivity of at least 4 to 6 weeks. Usually, drug combinations are prescribed to achieve a more significant effect. These can be combinations of ampicillin-sulbactam with gentamycin or vancomycin, vancomycin and ciprofloxacin. In addition to antibiotics in the treatment of infective endocarditis, agents that affect the immune system and anti-infective protection are used: immunoglobulin complexes, glucocorticosteroids in small doses.

For treatment of endocarditis not of a bacterial nature, it is necessary to take into account the specificity of the underlying disease. At an endocrine pathology it is necessary to hand over analyzes on hormones and to pass or take place course of treatment at the endocrinologist. Alcohol and toxic endocarditis is treated by reversing or stopping the use of one or another toxin.

Surgical treatment consists in excision of the affected area of ​​the heart valve with subsequent prosthetics, if possible, a plastic surgery is performed to preserve the patient's own valves. After hospital treatment, there comes a period of outpatient follow-up. Within 6 months, you need to undergo monthly examinations to identify a possible recurrence of infection and control the general condition. Subsequently, the examinations are carried out twice a year.

Complications that can occur with endocarditis.

The main mechanism for the development of complications is that proliferation on the valves of the heart can come off and with the flow of blood to fly to various organs and systems. Stuck in a small vessel, they will cause an acute shortage of blood supply and the death of this or that tissue. Renal damage in the form of glomerulonephritis, abscess and kidney infarction. The defeat of the nervous system in the form of strokes, abscesses and meningitis. And the most formidable complication is thromboembolism of the pulmonary artery, which can bring to sudden death.

Prognosis for endocarditis.

The prognosis for endocarditis remains serious. If the patient has infective endocarditis of the right heart because of drug injection, timely treatment will increase the chance of survival by 85%.

Endocarditis of a fungal nature results in 80% of cases of lethality.

Patients.who have endocarditis, have a very high risk of embolic complications and long-term relapse of the disease.

Prevention.

Because drug addicts are at the core risk, a timely withdrawal of drugs is necessary. People with artificial valves or chronic heart disease need constant monitoring of medical personnel. It is very important that patients follow the quality of medical equipment processing and are interested in the quality of sterilization. Be healthy!

Doctor therapist Zhumagaziev E.N.