Causes of endocarditis, symptoms and ways of treatment

Endocarditis is a pathological process, during which the inner shell of the heart is affected, as well as aortic and cardiac valves.

This disease is extremely dangerous not only for health, but for human life. If untimely initiation of treatment, the consequences can be the saddest, up to the development of cardiac deficiency, blockage of the blood vessels of internal organs and the emergence of immune diseases.

Endocarditis can have an infectious (bacterial) and non-infectious nature. And although it is often the first type of endocarditis, there are cases of its development against the background of immunopathological processes and mechanical damage to the walls of the heart.

What is it in simple words?

Endocardium is the inner shell of the heart, with the inflammation of which develops a disease called endocarditis. The acute form of the disease is often not an independent disease - this is just one of the manifestations of other pathological processes taking place in the patient's body.

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About endocarditis, as an independent disease, they speak only in the case of its subacute flow. In such a situation, it is often caused by a streptococcal infection.

Epidemiology

The disease occurs in people in all countries of the world without exception, and most often it develops in males. The incidence is 3.1 - 11.6% per 100 000 inhabitants.

In recent years, endocarditis is increasingly affecting people of advanced age. So, if in developed countries this pathology was sick people 35-40 years old, today patients suffering from it are over 50 people. At the same time, there is a risk of developing endocarditis much higher in young children. In particular, this applies to children who have been diagnosed with congenital heart disease.

The death rate from this disease varies in the range of 15-45%.

Causes of the disease

The type of endocarditis depends on whether it was caused by a bacterial infection, or whether it developed under the influence of other diseases.

So, infectious endocarditis can be:

virus;
fungal;
bacterial.

The most common is bacterial endocarditis, which develops under the influence of pathogens that can enter the inner walls of the heart through the blood from:

purulent rash on the body;
inflamed or clogged with purulent plugs of the tonsils;
teeth affected by caries;
organs of the respiratory system (with the infectious nature of the existing disease).

The pathology of the genitourinary sphere, as well as infection during the process of prosthetics of the heart valves, can also cause the development of bacterial endocarditis.

Noninfectious endocarditis

The development of non-infective endocarditis often occurs under the influence of autoimmune diseases. In this case, the human body begins to produce autoimmune antibodies that attack not alien, but healthy, pathologically unchanged cells. As a result, aseptic endocarditis develops, which, in turn, can lead to valvular heart disease.

One of the most common causes of non-infective endocarditis is rheumatism. It is a disease that is allergic in nature, and often develops against a background of sore throat caused by a green streptococcus. In the advanced stage of tonsillitis, the damage to the heart tissue also occurs, and the endocardium suffers primarily from the pathological process.

The development of endocarditis is not the last effect of the transferred angina streptococcal etiology. These microorganisms produce a specific M-protein, because of its entry into the blood, there is an acute autoimmune reaction of the body to the connective tissue. And although streptococci do not take an active part in the development of inflammatory processes in the endocardium, nevertheless, endocarditis after the course of therapy for tonsillitis - the phenomenon is not so rare.

The development of endocarditis in young children requires special attention. Pathology can be both congenital and acquired.

Thus, congenital endocarditis is a consequence of diseases of an infectious origin, transmitted by a pregnant woman. The same factors, as in adults, can serve as the reasons for the acquired form of pathology.

Pathogenesis

For the development of endocarditis, certain conditions are necessary, which are often associated with the prolonged exposure of the infectious agent to the endocardium. So, in this case lead to a pathological process can tonsillitis, furunculosis, periodontitis, etc.

The causes of acquired endocarditis include the penetration of a bacterial infection into the blood, resulting from:

surgical interventions in the field of different internal organs;
tooth extraction;
insertion of a catheter into a vein or bladder, etc .;
bronchoscopy;
intravenous administration of drugs, etc.

The pathological process is often localized on those heart valves that were previously susceptible to changes due to congenital, rheumatic defeats of the heart, or after a patient's prosthetic heart valves. Most often, the following valves are affected:

aortic;
tricuspid;
mitral;
pulmonary.

In this case, the tricuspid and pulmonary heart valve is most often subjected to changes in injecting drug users.

The basis of the pathological process is destructive-ulcerative endocarditis, accompanied by thromboembolic overlap. They subsequently lead to the development of thromboembolism.

In addition, in the development of endocarditis directly involved autoimmune mechanisms of the body. In the study of blood, a large number of antibodies to certain representatives of pathogenic microflora are found. Also, circulating immune complexes are identified that can lead to the development of vasculitis or glomerulonephritis.

Classification

Endocarditis in its origin is:

primary, when the pathological process develops in the field of absolutely healthy valves;
secondary, developing on previously altered heart valves (due to congenital malformations, rheumatism, etc.).

According to the classification of the clinical course, endocarditis occurs:

Acute, the symptomatology of which persists for 1-2 months. Common causes of this form of endocarditis is sepsis caused by streptococcal microflora, trauma, medical or diagnostic intervention in the heart area.
Subacute. This phase can last 2 months or more. It develops on the background of untreated acute endocarditis.
Chronic, prone to relapse. The clinical picture of this form of endocarditis can persist for half a year. Chronization of the pathological process can occur against a backdrop of profound myocardial damage, or in violation of the functions of the valve apparatus.

Chronic endocarditis is common in newborn babies and babies with congenital heart defects. This form of pathological process is also widespread among drug addicts and patients who underwent surgery.

Symptoms

Clinical manifestations of endocarditis are directly dependent on its type. They can grow and fall, change each other or manifest all together.

For acute endocarditis is characterized by the presence of:

febrile or pyretic fever;
a strong chill that is especially acute when the body temperature rises;
hyperhidrosis;
joint and muscle pain;
physical weakness, retardation;
headaches;
grayish or yellowish skin tone (sometimes with the appearance of red spots on it);
bile nodules, localized on the fingers of the upper limbs;
hemorrhages in the conjunctiva.

For subacute infectious endocarditis is characterized by the appearance of the following symptoms:

febrile fever;
sleep disorders;
trembling in the body;
causeless weight loss;
purchase of coffee-milk shade by the skin;
the appearance of a red rash all over the body;
the occurrence of subcutaneous small painful nodules.

Chronic form of endocarditis is characterized by the same clinical manifestations, which can hold for 6 months or more. During this period of time, there is a significant decrease in body weight, and the fingers of the patient acquire a tint of drum sticks. Nails become dull and fragile, begin to separate and break. Under the fingernails there are numerous hemorrhages, and on the skin of the hands and feet painful plaques are formed.

The development of heart disease, in the first place, is signaled by shortness of breath. Initially, it manifests itself under physical stress, but eventually it also appears in a state of absolute rest. The patient is concerned about the pain behind the sternum, the heart rate rises. At these anomalies, the temperature of the patient's body has no effect.

With the development of glomerulonephritis or infarction of the kidney, first of all, the patient's face develops swelling. Then there is a violation of the process of urination, the volume of daily urine released decreases. Urine becomes reddish, gets an unpleasant smell, and this process is accompanied by an increase in body temperature and intense pain in the lower back.

Thromboembolism of the pulmonary artery is characterized by severe shortness of breath and a feeling of acute shortage of air. The patient complains of pain behind the sternum. Against the background of oxygen starvation, the complexion becomes purple or cyanotic, serious disturbances occur in the mind.

Symptomatic of infective endocarditis develops in 3 stages:

Infectious-toxic. At this time pathogenic microorganisms penetrate into the blood and "settle" on the heart valves. Rapidly multiplying, they form specific growths - vegetation.
Infectious-allergic, when there is an activation of the immune system in response to an attack of pathogenic microflora. In this case, the internal organs are damaged: kidneys, liver, myocardium, etc.
Dystrophic. For this phase of development of endocarditis is characterized by the occurrence of severe complications. There is necrosis of the heart tissues and severe damage to many organs of internal secretion.

If endocarditis is rheumatic, it develops, as a rule, against the background of the transferred glomerulonephritis or tonsillitis, accompanied by the release of a specific beta-hemolytic streptococcus. After attenuation of the symptoms of the pathological process, the patient complains of a decline in strength, weakness, general malaise and rapid fatigue.

Then fever develops again - subfebrile or even febrile. The patient complains of pressing, stitching or aching sensations in the region of the heart. Against this background, other symptoms of rheumatism may appear: in particular, the periodic enlargement of large joints, their soreness. These signs pass by themselves, but are prone to a new occurrence.

Dangers and Complications

The most common complications of endocarditis include:

development of chronic heart failure;
thromboembolism;
vices or chronic inflammation of the heart valves.

Let's consider each of the situations in more detail.

With chronic heart failure, the pump and contractile function of the heart is significantly reduced. This deviation is due to damage to the myocardium and heart valves.
Thromboembolism is one of the most dangerous complications of endocarditis. When the thrombus is severed, it can occur in a small circle of blood circulation, which, in turn, can lead to blockage of the pulmonary artery. Penetration of the blood clot into a large circle of blood flow causes disruption of blood circulation in many internal organs and parts of the body: limbs, spleen, gastrointestinal tract, etc.
Prolonged chronic inflammation. Long-term exposure to pathogenic microflora in endocarditis can lead to the formation of multiple abscesses in the body. This, in turn, can cause the development of sepsis.

Often, infectious endocarditis develops renal and hepatic insufficiency. To no less serious complications of pathology can also be attributed:

embologogenic heart attacks and strokes;
inflammatory processes in the tissues of the membrane of the brain;
formation of intracranial abscesses;
pneumonia;
phlebitis;
thrombosis, etc.

In particularly severe cases, a lethal outcome is possible.

Diagnostics

In order to make sure the diagnosis is correct, the doctor, first of all, conducts an anamnesis. During the interview of the patient, he reveals his propensity for cardiovascular disease, carefully examines the patient's symptomatology and the frequency of its manifestations.

A great value in the diagnosis plays auscultation and percussion of the heart area. As a result of inflammation, there is a violation of the body, which is fixed by the doctor when performing these manipulations.

Based on the findings, the cardiologist concludes that it is necessary to perform instrumental and laboratory diagnostic procedures:

An expanded blood test. With endocarditis, there is an increase in ESR and an increase in the level of leukocytes.
Bacteriological study of venous blood, which is carried out three times. It is necessary to determine the specific type of pathogenic microorganisms in case of suspected infectious nature of endocarditis.
Echocardiography.
Ultrasound.

With the help of the last two procedures, the presence of vegetation in the heart area, as well as its structural changes, is revealed.

Treatment of infectious and non-infective endocarditis

With a relatively easy flow of infective endocarditis, antibiotic therapy is practiced, with severe - surgical excision of inflamed cardiac tissues. If there is a heart disease, all efforts of doctors should be aimed at correcting the functioning of the body.

Antibiotics for treatmentinfectious endocarditisappointed exclusively by a doctor! The course of therapy lasts from 4 to 6 weeks. Combined antimicrobials are often prescribed to achieve a more pronounced and quick treatment result. In addition to antibiotic therapy, general restorative treatment is performed. It is based on the use of immunoglobulins, anti-infectious drugs and hormones from the GCS group.

Ifendocarditis is noninfectious in naturep, then its treatment depends on the specificity of the underlying disease. With pathology of the endocrine system, it is necessary to pass a blood test from the vein to determine the level of hormones. If deviations are found, the patient will need to undergo a course of therapy with the endocrinologist.

Endocarditis, caused by alcohol intoxication or poisoning by harmful substances, is treated by refusal or exclusion of contact with the toxin.

Operation

The operation with endocarditis consists in excision of the affected parts of the heart valve and their subsequent prosthetics. If it is possible to perform a plastic surgery, then the need to replace the natural valves with artificial ones disappears.

After discharge from the hospital, the patient must undergo an additional course of outpatient follow-up. For six months he will have to visit the clinic monthly for regular check-ups with a doctor who will evaluate the effectiveness of the therapy and the risk of a relapse of the pathology. After that, the medical examinations will be held twice a year.

Forecast for life

The prognosis of life after endocarditis is conditionally unfavorable. Even with broad-spectrum antibiotics, 30% of patients die from severe complications. However, timely antibiotic therapy increases the patient's chances of complete recovery and recovery.

Relapses of endocarditis occur 4 weeks after the treatment. They can occur due to improperly selected antibiotics or inappropriate application. A repeated outbreak of the disease leads to severe damage to the heart valves, and also increases the risk of developing CHF.

Prophylaxis of endocarditis

To prevent the development of endocarditis, it is necessary:

timely identify and treat infectious diseases: caries, tonsillitis, bacterial pathologies of the mouth and nasopharynx;
regularly conduct preventive antibiotic therapy in persons who are at risk;
avoid stress;
give preference to moderate physical exertion;
time to treat viral diseases;
strengthen the immune system;
to carry out immunization of CPC.

Patients who have had previous endocarditis should undergo regular medical examinations on a regular basis. Good help to restore the body courses of sanatorium treatment.

And the main thing: that the illness does not remind itself of itself any more, a person should take good care of his health. If you have any anxiety symptoms, you should discard the idea of self-treatment, and contact a competent medical specialist.

To what doctor to address?

Endocarditis is treated by a cardiologist. But in some cases the patient may be referred for additional consultation to other specialists:

nephrologist;
hepatologist;
rheumatologist;
orthopedist;
narcologist.

If the complication of endocarditis is the rupture of the spleen, the patient is referred to the surgeon. If necessary, prosthetics of the affected valves requires the intervention of a cardiac surgeon.