Endocarditis - what it is, how it manifests itself and what is dangerous

Today, carditis is increasingly coming to the forefront of cardiovascular diseases - the main cause of adult mortality.

They are especially dangerous for the development of life-threatening complications, so their diagnosis and treatment are one of the main directions of the fundamental medical science in the field of cardiology.

What is endocarditis? It is an infectious and inflammatory heart disease of an acute or chronic nature, in which the inner membrane of the atria and ventricles becomes the main target of pathogenic microorganisms, as well as the valve apparatus.

Epidemiology

Disease is common in all countries of the world anddifferent climatic zones. The incidence is in the range of 3.1 to 11.6 per 100,000 inhabitants. Men suffer from infectious endocarditis 2-3 times more often than women.

Recently, in developed countries, there is a clear "aging" of this pathology. Previously, the average age of patients with infective endocarditis was 35 years, but now it is 50. The risk of developing the disease in early childhood is also higher, especially if there are congenital heart defects.

Mortality in this disease varies from 15 to 45%.

Reasons and risk factors for

• Rheumatism .

  In rheumatism, the leading etiological agent is the beta-hemolytic streptococcus of group A, which, with blood flow, penetrates into the heart structures.

  Having a structure similar to the connective tissue membranes of this hollow muscular organ, it provokes a false immune response, as a result of which mitral, tricuspid and aortic valves are damaged, and rheumatic endocarditis occurs.

• Infection with .

  Among the microbial factors, the main role is played by bacteria - gram-positive pathogenic flora: streptococci, in particular group D streptococcus and enterococci, as well as staphylococci and pneumococci.

  Pathogens from the group of Gram-negative rods are much less common. Especially pathogenic are salmonella, legionella, shigella and pseudomonas.

  Fungal form of endocarditis is also infrequent: it usually occurs as a complication of prolonged antibiotic therapy in the postoperative period or to prevent secondary infection with established vascular catheters.

• Injuries and surgeries.

  Surgical interventions, diagnostic and therapeutic invasive procedures( central vein catheterization, colonic and cystoscopy, parenteral administration of drugs, hemodialysis, etc.) create an entrance gate for penetration into the vasculature of pathogens that can cause inflammation.

Among the predisposing factors of endocarditis development it is possible to note:

• latent foci of dormant infection of different localization: tonsillitis, carious teeth;
• congenital and acquired heart defects, hereditary anomalies of its development;
• primary and secondary immunodeficiency;
• stress, sluggish chronic diseases, which weaken the defenses of the body;
• addiction;
• old age.

Classification

By origin:

• primary : occurs on healthy heart valves;
• secondary : develops on pathologically altered structures of the heart and vessels for rheumatism, congenital and acquired defects, syphilis, after surgery for valve replacement, etc.

On clinical course there are:

• acute : lasts up to 2 months. The reason - sepsis of staphylococcus origin, trauma and therapeutic and diagnostic manipulations in the cardiovascular system. With this form of inflammation, the infectious-toxic manifestations rapidly increase, as well as the vegetation of the valves and thrombus formation, frequent purulent metastases to various organs;
• subacute : lasts more than 2 months. It develops with inadequate therapy of acute endocarditis;
• chronic recurrent : more than 6 months. Formed with deep damage to the myocardium or dysfunction of the valve apparatus. It is more common in newborns and infants with hereditary heart defects, drug addicts and persons who underwent surgical interventions.

Danger and complications of

Among the main complications include chronic heart failure( CHF), thromboembolism, heart valve defects and chronic inflammatory condition.

• CHF is caused by a decrease in contractile and pump function .It is based on damage to the myocardium and the pathology of the valves.
• Thromboembolism is a formidable complication of endocarditis. In the case of detachment of a blood clot depending on its location, it falls into either a small circle of blood circulation, leading to a blockage of the pulmonary artery, or to a large one, provoking an acute disturbance of blood flow in various internal organs: the spleen, brain, extremities, gastrointestinal tract or retinaeyes.
• Chronic chronic process .Prolonged bacteremia - persistence of microbial agents with blood flow - can lead to the appearance of new purulent metastases in the body, as well as to the generalization of infection with the development of sepsis.

In addition to cardiac complications, infective endocarditis can initiate renal and hepatic insufficiency, embologenic infarction or stroke, inflammation of the brain envelopes, intracranial abscesses, abscesses in the liver and lungs, thrombosis, angiitis, phlebitis, pneumonia and hepatitis.

Symptoms and signs of

When developing endocarditis in adults , the following symptoms of can be identified:

• dyspnea;
• tachycardia;
• fast fatigue;
• pallor of the skin;
• edema and pastovoznost lower extremities, in neglected cases - ascites.

All this speaks about the formation of the flaws in the valves, which leads to disruption of the heart and chronic cardiovascular failure.

In favor of the infectious nature of the disease, is also described as typical signs of an inflammatory process:

• fever: with acute endocarditis, high fever is of a hectic nature, with subacute - often subfebrile temperature;
• polymyartralgia;
• chills;
• hyperhidrosis.

When specifying the diagnosis of , great importance is attached to dermatological manifestations:

• pinpoint hemorrhages on the skin, mucous membranes and transitional fold of the conjunctiva;
• subcutaneous hematomas and bruises due to the fragility of capillaries and immune vasculitis;
• Osler nodules - dense reddish-purple thickening on the palmar and plantar surfaces, fingers, painful on palpation.

To which doctor to seek help from

Any problems of the cardiovascular system, including endocarditis, are in the competence of doctors of the cardiological profile.

In the absence of such specialists at the place of residence, it is necessary for to attend an appointment with the therapist of the polyclinic department, which will already give a referral for a doctor's consultation.

Follow-up of patients is performed by the cardiologist .The latter, after carrying out the necessary minimum of diagnostic measures, will select an adequate treatment tactic.

Depending on the degree of heart attack of the patient, the curator can collect a consultation involving a bacteriologist, cardiac surgeon, ophthalmologist and other specialists to decide whether to proceed surgically or to continue conservative drug therapy.

Diagnostics

Physical examination:

• A history of .Interrogation of the patient for the detection of previous infectious diseases, especially rheumatism, as well as the presence in the history of the disease episodes of surgical interventions or therapeutic and diagnostic manipulations.
• Visual inspection of the .An indirect sign of endocarditis can be pustular rash, skin sympathetic complex( petechiae, hemorrhages, Osler's nodules, Rota spots), as well as the presence of rheumatic deformity of the joints. Infringement of blood supply of tissues is detected by anemic skin, acrocyanosis of the tip of the nose, lips and fingers, as well as asthenic syndrome.
• Palpation of the .This method has no important diagnostic value, however, with sepsis regional lymph nodes can increase: axillary, chin and inguinal. When palpating in the region of the heart beat, its habitual localization is often changed - in the fifth intercostal space.
• Percussion .This way of tapping the boundaries of the heart allows you to determine the increase in its size, which is often observed with endocarditis due to hypertrophy of the left ventricular myocardium and congestive heart failure.
• Auscultation .A fairly informative method that allows us to determine with the help of a stethoscope the weakening of the first and second tones in the area of ​​the projection of the heart valves, as well as pathological noise.

Laboratory diagnostics:

1. General blood test:

   • normochromic anemia;
   • increase in ESR;
   • shift of the leukocyte formula to the left;
   • thrombocytopenia;
   • is a dysproteinemia.

2. Biochemical blood test:

   • hyperparaphrenic and gammaglobulinemia;
   • high level of circulating immune complexes, C-reactive protein and creatinine;
   • increase in IgM titer;
   • detection of a positive rheumatoid factor.

3. Bacteriological analysis:

   The identification of the pathogen plays an important role in the diagnosis of the disease.

   In acute endocarditis, the biological fluid is taken three times at 30-minute intervals, and with subacute - 3 times during the day. Such a number of samples excludes the probability of accidental insemination of the biomaterial by pathogens, which distorts the veracity of the results obtained.