Hospital therapy. Pathogenesis and classification of infective endocarditis (IE) (most important)

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Hospital therapy. Pathogenesis and classification of infective endocarditis (IE) (most important)

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18. Pathogenesis and classification of infective endocarditis (IE)

Pathogenesis. The mechanism of development of IE is complex and not well understood. In the development of the disease, 3 stages can be distinguished.

Stage I (infectious-toxic) proceeds with varying degrees of severity of intoxication. There is a growth of bacteria, the destruction of valves, leading to the development of heart disease; at the same stage, a generalization of the process often occurs due to the hematogenous spread of infection - pieces of cusps or colonies of microorganisms can separate from the valve, the cusps can rupture.

Stage II - immuno-inflammatory, in which microorganisms fixed on the valves cause prolonged autosensitization and hyperergic damage to the organs and tissues of the body (immune generalization of the process).

Stage III - dystrophic - occurs with the progression of the pathological process: the functions of a number of organs are disturbed, heart and kidney failure occurs, further aggravating the course of the disease (see table).

Table Classification of IE

A distinction is also made between active and inactive (healed) IE. There is also a surgical classification, in which they distinguish:

1) the lesion is limited to the valve leaflets;

2) the lesion extends beyond the valve. Acute IE (rapidly progressive, develops over 8-10 weeks) is rare, usually in individuals who have not previously had heart disease, and is clinically manifested by a picture of general sepsis.

Subacute IE (most common) lasts 3-4 months, with adequate drug therapy, remission may occur.

Protracted IE lasts for many months with periods of exacerbation and remission, it is characterized by mild clinical manifestations. With an unfavorable course, severe complications arise, and patients die from progressive heart failure, increasing septic intoxication.

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