Internal illnesses. Infective endocarditis (most important)

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Internal illnesses. Infective endocarditis (most important)

Lecture notes, cheat sheets

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7. INFECTIOUS ENDOCARDITIS

A peculiar form of sepsis, characterized by the localization of the pathogen on the heart valves or parietal endocardium, followed by damage to many organs and systems.

Etiology. Pathogens: cocci, gram-negative bacteria, fungi such as Candida, rickettsia, viruses, Brucella.

Risk factors: acquired and congenital heart defects, minor surgical and dental operations, parenteral drug administration, prosthetic heart valves, urinary tract infection, prolonged use of catheters, abortions, program hemodialysis.

Classification. Taken into account:

1) clinical and morphological form: primary (on unchanged valves) and secondary (against the background of rheumatic, syphilitic, atherosclerotic, defects, arteriovenous aneurysms, prosthetic valves);

2) the nature of the course (acute, subacute, chronic (recurrent));

3) the degree of activity of the process: I degree - minimal, II degree - moderate, III degree - high.

Clinic. The main manifestations of the disease: fever (from subfebrile to high), accompanied by chills, profuse sweating, muscle weakness, muscle and joint pain, loss of appetite.

The skin is pale with an icteric tint, petechial rashes, especially on the skin of the lower eyelid (Lukin-Libman symptom), painful nodules on the palms and soles (Osler's nodes). Fingers in the form of drumsticks, nails - watch glasses.

Tachycardia, muffled heart sounds, rhythm and conduction disturbances, which is typical for developing myocarditis. systolic murmur over the aorta due to narrowing of the aortic orifice. Occurs a few weeks after the onset of the disease. With the development of aortic insufficiency, diastolic murmur appears over the aorta.

Diagnostic research. Complete blood count (anemia, leukopenia, thrombocytopenia, increased ESR). Biochemical blood test - dysproteinemia, hypergammaglobulinemia, positive formol test.

Immunological study - inhibition of the non-specific link of the immune response, activation of the humoral link (increase in IgA, IgM, CEC).

Bacteriological examination of blood (triple blood cultures).

With an ECG - a violation of the rhythm and conduction, a decrease in the voltage of the teeth. Echocardiography: the presence of vegetations on the cusps of the affected valve, signs of a formed heart disease, ruptures of chords, perforation of the cusps.

Complications. Infarction of the lungs, myocardium, kidneys, pulmonary edema, heart failure, embolic disorders of cerebral circulation of the spleen, retinal vessels.

Treatment. Administration of the antistaphylococcal penicillinase-resistant antibiotic oxacillin, 2 g every 4 hours (12 g/day).

Prednisolone (40-60 mg / day), non-steroidal anti-inflammatory drugs.

Cardiac glycosides, potassium preparations, diuretics, for anemia - iron preparations in combination with vitamins B and C in the dystrophic phase.

Flow. In the acute form it is rapidly progressive, in the subacute form it is protracted, in the chronic form it is recurrent.

Forecast. In the acute form, the prognosis is relatively favorable; in subacute and chronic forms, the prognosis is relatively favorable.

Prevention. Prevention of the development of bacterial infections, active treatment of acute infections.

Author: Myshkina A.K.

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