Infective endocarditis is a disease that inflames the inner walls of the heart (endocardium) and large adjacent vessels, as well as heart valves. Infectious endocarditis is caused by various types of microorganisms:
- streptococci;
- staphylococci;
- enterococci;
- Pseudomonas aeruginosa;
- fungi of the genus Candida, etc.
The probability of infectious endocarditis
Infection often affects the pathologically altered heart valve or endocardium. The risk group includes patients with rheumatic, atherosclerotic and traumatic valve injuries. Also, the disease is common in people with valve prostheses and artificial pacemakers. The risk of developing infectious endocarditis increases with prolonged intravenous infusions and against immunodeficiency states.
Symptoms of infective endocarditis
The main manifestations of the disease are:
- fever (constant or wavy);
- sweating;
- general weakness, fatigue;
- pain in the chest;
- tachycardia;
- decreased body weight;
- joint pain;
- dry skin;
- skin rash;
- haemorrhage to the retina, etc.
Infective endocarditis - classification
Until recently, infectious endocarditis was divided into acute and subacute. Today this terminology is not used, and the disease is classified as follows.
By localization:
- left-handed native valve;
- left-sided prosthetic valve (early and late);
- right-sided;
- associated with the installation of the device.
By the method of infection:
- related to medical care;
- out-of-hospital;
- associated with intravenous drug use.
According to the form of the disease:
- active;
- returnable.
Diagnosis of infective endocarditis
To establish an accurate diagnosis, the following diagnostic methods are required:
- palpation and percussion of the heart;
- clinical and biochemical blood test (multiple);
- echocardiography.
Complications of infective endocarditis
With this disease, the infection can quickly spread to other organs, causing the following diseases:
- From the kidneys: diffuse glomerulonephritis, nephrotic syndrome, focal nephritis, acute renal failure.
- From the liver: cirrhosis , hepatitis, abscess.
- From the side of the spleen: abscess, splenomegaly, infarction.
- From the side of the lungs: pulmonary hypertension, infarction pneumonia, abscess.
- From the side of the central nervous system: cerebral abscess, acute disturbance of cerebral circulation, meningitis , meningoencephalitis, hemiplegia.
- From the side of the vessels: thromboses, vasculitis, aneurysms.
If infectious endocarditis is not treated, it can lead to fatal complications:
- septic shock;
- multiple organ failure;
- acute heart failure;
- embolism in the brain.
Treatment of infective endocarditis
When the diagnosis of "infective endocarditis" is immediately proceeded to antibiotic therapy. The choice of the drug depends on the type of pathogen and its sensitivity to antibiotics. The drug is administered intravenously at certain intervals between injections (to maintain the optimal concentration of antibiotic in the blood). Also, anti-inflammatory drugs, diuretics, antiarrhythmics, etc. can be prescribed. The duration of treatment is at least a month. In the course of treatment, regular diagnostic tests are carried out.
Surgical treatment is required when:
- lack of the proper effect of antibiotic therapy;
- chronic heart failure;
- sepsis;
- an abscess of the heart;
- involvement in the process of the prosthesis valve;
- recurrent embolism.
Prophylaxis of infective endocarditis
Prevention of the disease, which consists in taking antibiotics, is carried out in patients at risk in such cases:
- with dental and other manipulations on the oral, nasal cavity, respiratory tract and in the middle ear, which are accompanied by bleeding;
- with gastrointestinal and urological surgical interventions.