Septic endocarditis is a disease that develops against the background of a general septic state of the body with inflammation of the endocardium and damage to the heart valves.
This pathology occurs as a result of the infiltration from the infectious focus of microbes, most often belonging to the coccus group. Consider all features of endocarditis, which causes sepsis of the heart.
General Information
The overall picture of septic endocarditis is pathogen dependent. Fungal infections and Gram-negative microflora rarely cause this disease, and most often develops such endocarditis in addicts or people who have artificial valves .Streptococci can cause subacute or acute endocarditis.
Subacute septic endocarditis is characterized by symptoms such as general weakness, fatigue, weight loss, the appearance of subfebrile temperature. Also possible immunocomplex lesions of organs ( nephritis, arthralgia) and development of embolic complications( strokes, renal infarcts).
Causes and risk factors
Most often, subacute complications occur on previously modified valves. Elderly people are most susceptible to the occurrence of endocarditis of the left heart chambers of with mitral and aortic valve damage, previously having changes.
Dental operations, instrumental examinations of the gastrointestinal tract, genitourinary tract, as well as bacteria from the foci of infection lead to heart damage most often. The lesion of the right heart chambers of the is most often developed in drug users and hospital patients who have established intravascular catheters.
Unfortunately, diagnose timely this disease is difficult .The diagnosis is often made after the formation of the pathology of the valves and the appearance of heart failure.
Prevalence of the disease
Septic myocarditis is divided into two types:
- primary - develops on intact valves( Chernogubov's disease);
- secondary - develops on valves previously having pathologies.
Secondary form of the disease is found in 70-80% of cases of , most often having previous rheumatic heart disease. Much less often - arisen in patients with atherosclerotic, syphilitic or congenital malformation.
The primary type of disease is found in 20-30% of all cases.
Danger and consequences of
Over the past few decades, morphological and clinical patterns have changed dramatically. Before, when antibiotics were practically not used, the septic endocarditis was considered the most serious disease leading to the death of .
Thanks to the large doses of antibiotics, the septic process on the heart valves is eliminated by the , the granulations in the leaf tissues ripen faster, eliminating the bacterial focus.
This causes deformation of the valves and the development or aggravation of the already existing pathology of the heart.
At autopsy, is usually found with aortic heart disease with a strong degree of valve changes, perforation of the valves, and severe myocardial pathologies.
Symptoms of
Symptoms of septic endocarditis are general weakness, dyspnea. The low-grade temperature is maintained, but the occasionally rises above 39 degrees .Chills and sweating are also common.
The patient has pallor, which is caused by anemia and abnormalities of the aortic valve. Some have gray-yellowish skin, subcutaneous hemorrhages, which also appear on the folds of the eyelids and conjunctiva. This is due to the fragility of the capillaries.
More often in patients the fingers become like drumsticks, and the nails on the watch glass.
Diagnostics of
When examining the heart, noise is often detected. Subacute endocarditis is characterized by embolisms in the kidney vessels, as well as in the vessels of the spleen, extremities, gastrointestinal tract. Often the spleen is enlarged, glomerulonephritis having a focal shape is found.
In urinalysis, small proteinuria and hematuria are found. Sometimes the appearance of diffuse glomerulonephritis, as a result of the influence of the products of the breakdown of proteins. In the blood, is found to vary the number of leukocytes, the number of eosinophils is reduced by .In biochemical analysis, disproteinemia is observed, thymol and mold samples are positive. Sowing blood reveals the presence of bacteria.
Tactics of treatment and prognosis
Therapy of septic endocarditis is carried out by with large doses of antibacterial drugs, vitamins and other means that help strengthen the body.
The most effective remedy is penicillin, sometimes in combination with streptomycin .Within one month, penicillin is administered daily at a dosage of 500,000-1500,000 units. This course is then repeated several times with small interruptions. The most effective treatment if it is carried out at the very beginning of the disease.
As an additional therapy, use means that increase the body's resistance and increase the effect of antibiotics. Also the purpose of such treatment is delay in the removal of antibacterial drugs, prevention of blood clots on valves .
To improve immunity and improve the overall condition of the patient, is given vitamin therapy and a blood transfusion , if there are no contraindications to such a procedure.
If microbes resistant to penicillin are found during blood culture, is treated with sulfonamide preparations at high dosages of , and streptomycin. Also the patient is given disinfectants, sedatives, mixtures with polyvitamins.
When the treatment with penicillin is started in time, the temperature decreases, and severe pathologies of organs rarely occur. The patient recovers, or there is a prolonged remission.
If treatment is started already in the middle or late period, the patient's well-being improves, the temperature decreases, blood counts improve, the spleen decreases.
Sometimes, even after remission, signs of heart failure appear, leading the patient to death. It is important to know that even after the patient's condition is improved, the appearance of the next exacerbation of is possible.
If sepsis occurs as a result of a surgical procedure, is important to eliminate the infection focus. Therapy is performed with the use of antibiotics and other medications, and also use the method of blood transfusion. Penicillin is administered daily every 3 hours in a total dosage of up to 800,000 units.
Learn more about septic endocarditis from this video:
Preventative measures
Patients with existing heart defects should be monitored by specialists. In order to prevent the development of septic endocarditis, must be eliminated with focal infections. Especially it concerns diseases of a teeth, tonsils.
Septic myocarditis is a dangerous disease caused by the infection of the heart valves with damage to other organs. The initial stage of the disease is difficult to identify.
The timely treatment with antibacterial drugs significantly reduces the risk of developing severe heart valve lesions.
After a blood culture, treatment with penicillin or streptomycin is started in large doses with repeated courses. It is important to remember that even after prolonged remission, there may be an exacerbation or a new sepsis, which leads to heart failure and death.
The patient should ensure peace, bed rest, easy vitaminized nutrition, protection against infections .After proper therapy, in most cases there is a general improvement in the patient's condition.
