Cardiology

Infective endocarditis: sepsis with development of heart disease

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Infective endocarditis is one of the most common causes of acquired heart defects — a defect in the valve, which interferes with the normal pumping function of the heart by “pumping” blood.

What is infective endocarditis? This is a serious infectious process in the body with a primary lesion of the endocardium, the inner lining of the heart, which forms the valves. It is a systemic (widespread) disease, in fact — sepsis (blood poisoning), which affects many internal organs, not just heart.

Causes of infectious endocarditis

As with any infection to emergence of infective endocarditis requires the presence of two factors:

  • Pathogen. The most commonly cause infective endocarditis are Staphylococcus aureus, Enterococcus, viridans Streptococcus. Less common are Escherichia, Pseudomonas, Proteus, Mycoplasma, chlamydia, fungi (Candida, Aspergillus), etc.
  • A violation of (weakening) of the immune system, which can be caused by any of the previous a chronic disease, unfavorable environment, alcoholism, etc.

In order to cause endocarditis, the pathogen must get into the blood system. Blood normally a person is sterile, ie it contains no germs. Standing in their way is a lot of screens.

How do bacteria, viruses or fungi penetrate? Or the so-called “primary focus of infection” such as purulent otitis media, or when performing medical examinations, manipulations and operations. What about the use of sterile disposable instruments, you ask? Sometimes there are situations when even the most thorough implementation of the principles of asepsis (sterility) may not help prevent infection. These situations are called risk factors.

Risk factors for infective endocarditis

  • All dental procedures, especially the removal of carious teeth. Why? Mouth is full of germs. And mouth cannot be sterilized at all desire. When you remove a tooth damaged vessels within these lesions can penetrate the germs.
  • Removal of tonsils (tonsillectomy).
  • Operations on the esophagus, the intestine.
  • Urological manipulations and operations, especially urolithiasis and pyelonephritis concomitant, the necessity of insertion of a urinary catheter for a long time, etc.
  • Gynecological intervention, especially abortion.
  • Prolonged catheterization of the vein.
  • Artificial lung ventilation (ALV), intubation (breathing tube installation into the trachea).

In all these situations, the inability to achieve complete sterility combined with damage to the tissues and blood vessels. If in protecting the body has a “flaw”, the probability of introduction of infection and development of disease increases dramatically.

Also, there is another powerful risk factor for endocarditis is the presence of previous heart disease, large blood vessels (e.g. aortic aneurysm) or heart disease rheumatic, atherosclerotic origin. In such a modified, already affected by disease of the valves and endocardium, easily breeds infection. There is a so-called secondary infective endocarditis. It affects and artificial valves.

How is heart disease?

Bacteria with the blood entered into the heart, where it ends up on the valves and actively proliferate, forming a secondary infectious (septic) home. Their mass forms of vegetation (growths) on the valves. The valves are “eaten” infectious process, deformed, no longer completely close (insufficiency occurs with a reverse flow of blood) or Vice versa, fused, and the valve may not open fully when you need to skip the necessary amount of blood (stenosis). Especially often suffer from aortic valve, although other localization or failure of several valves is also not excluded.

Vegetation of bacteria can break away and travel to other organs the blood vessels of spleen, intestine, kidneys, eyes. They block the blood flow in the organs (embolism), and there occurs infarction (tissue death from lack of oxygen and nutrition). If you are logged small “pieces” of vegetari, a heart attack will not, and will develop infection in these organs.

The symptoms of infective endocarditis

One of the main and first symptom is a fever like no apparent reason. Fever may be constant and high, and maybe is undulating with occasional climbs during the day. The temperature is not reduced by the use of antipyretics and the usual short courses of antibiotics accompanied by strong chills and sweating. In some cases the fever is slight or absent altogether.

Hemorrhages on the right hand.There is a strong weakness, muscle pain, loss of appetite and weight loss, pallor due to intoxication. Often appear on the skin petechial rash is brownish color — hemorrhage. Increase or first appearance of signs of heart failure: palpitations and shortness of breath when walking, swelling.

A third of patients suffering with nervous system due to embolism by vegetariani. It shows weakness in the right or left half of the body, impaired vision, severe headaches.

Diagnosis of infectious endocarditis

First and foremost, it is based on the totality of symptoms and the identification of pre-disease risk factors (see above). If the patient has previously had heart disease, it is very often when joining endocarditis is changing auscultatory picture, ie noise, or worse, begin to “sound” differently.

To confirm the diagnosis cardiologist appointed:

  • repeated blood cultures to identify the causative agent, determine its type and sensitivity to antibiotics;
  • AJAX, which allows you to “see” growths on the valves, change the valve, to assess the degree of impairment of blood flow in the heart, the opposite of reflux (regurgitation);
  • blood tests. Characteristic for the majority of patients are anemia, increased leukocyte and erythrocyte sedimentation rate. Biochemical parameters (protein, bilirubin, transaminases, etc.) are changing in all different ways;
  • urine;
  • Ultrasound;
  • ECG.

Principles of treatment of infective endocarditis

The treatment is carried out in a hospital. The primary therapy is, of course, the use of antibiotics. Choose drugs with broad spectrum of action depending on the type of pathogen:

  • Penicillins (ampicillin, amoxicillin with clavulanic acid);
  • Cephalosporins of III generation (Ceftriaxone, Cefotaxime, ceftazidime);
  • Aminoglycoside (gentamicin, amikacin);
  • Vancomycin, daptomycin.

The duration of the first course of treatment is individual, from 3 to 8 weeks high doses, intravenous and intramuscular. Often use a combination of two antibacterial drugs.

In addition, use of antipyretics and antihistamines (anti-allergic) drugs, glucocorticoids, immunomodulators, drugs for the treatment of heart failure. Help in recovery and plasmapheresis blood irradiation with ultraviolet light, active detoxification therapy.

If the valves are irreversibly destroyed and heart failure is growing, not corrected with medication, then perform heart surgery to remove the infected areas and prosthetic valves.

Forecast

Recovery (formation defect) is observed in about half of the percent of cases. In 15-30% of the disease becomes chronic, with periods of exacerbation of infection and remission. Unfortunately, despite the efforts of doctors, and often fatal in 20-30%.

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