Bacterial endocarditis

Description:

The endocarditis is an inflammation of an internal cover of heart (endocardium). The endocarditis can be localized in different departments of heart: in the field of valves (a valve endocarditis), in the field of chords (a chordal endocarditis), in the field of a pristenochny endocardium (mural endocarditis). The valve endocarditis is dangerous by formation of heart disease.

Symptoms of the Bacterial endocarditis:

Acute infectious endocarditis. The clinical picture at the beginning of a disease is generally shown by symptoms of sepsis. Are characteristic high fever  with oznoba and perspiration; heavy intoxication with a headache, block, increase in a liver and spleen, hemorrhage on skin, mucous membranes, on an eyeground, formation of small painful small knots on the palmar surface of fingers of hands. Bacterial embolisms in various bodies with formation of the suppurative metastatic focuses are observed. Laboratory reveal anemia, a leukocytosis, increase in SOE. The first signs of damage of heart are tachycardia  and muting of cordial tones. Point change of the existing noise of heart or sudden emergence to actually endocarditis new owing to a valvulitis, a perforation of a shutter of the valve or a rupture of tendinous thread. Localization and the nature of noise allow to define a type of the forming heart disease. At considerable disturbance of an endocardiac hemodynamics symptoms of quickly accruing heart failure appear.
Subacute bacterial endocarditis. The clinical picture consists of symptoms of infectious process, immune disturbances and signs of defeat of valves of heart. Are noted fever  of the wrong type with tremendous oznoba, plentiful sweating; symptoms of intoxication — a joint pain and muscles, muscular weakness; as a rule, noticeable weight loss quickly develops. Quite often at patients a peculiar coloring of skin is observed (color of coffee with milk); a petekhialny enanthesis (comes to light up to widespread hemorrhagic rash) and a conjunctiva, painful hypodermic small knots near finger-tips (Osler's small knots), change of nails in the form of hour glasses and trailer phalanxes as drum sticks (see. Drum fingers). Often at a palpation the increased spleen is defined, is more rare — a liver. In blood find anemia, quite often a leykotsitopeniya (sometimes a leukocytosis), increase in SOE. In urine, as a rule, reveal a microhematuria and a microproteinuria. Sometimes the picture of a disease is erased — many of the listed symptoms are absent. In the first weeks, and sometimes and in the first 2 months of a disease of change of the valve device of heart can clinically not be defined. In the subsequent there are heart disease symptoms (as a rule, the aortal insufficiency which is usually connected with an aorta valve shutter perforation, occasionally — mitral insufficiency) or the auskultativny picture of already being available defect changes. Often there are vasculites, various tromboembolic episodes. Sometimes the heart attack of a kidney, spleen or lung appears a reason for the emergency hospitalization of the patient; perhaps also development of a myocardial infarction or hemorrhagic stroke.

Reasons of the Bacterial endocarditis:

Infection with streptococci, stafilokokka, fungi etc. is the reasons of a subacute bacterial endocarditis. Infection sources often are various medical procedures (stomatology, operative measures, injections etc.).

Treatment of the Bacterial endocarditis:

Treatment of an endocarditis consists in therapy of a basic disease, for example rheumatism, a system lupus erythematosus, sepsis, etc. At an infectious endocarditis the leading place is taken by active antibacterial therapy which should be begun in the earliest terms of a disease and to coordinate with results of crops of blood on flora and definition of sensitivity of microbes to antibiotics. At a subacute septic endocarditis from the very beginning use high doses of sodium salt of benzylpenicillin (to 60 — 80 million PIECES/days) or semi-synthetic penicillin (Oxacillinum, Methicillinum, etc.) or cephalosporins intravenously and (or) intramusculary in combination with gentamycin. If the disease is caused by staphylococcus, then the semi-synthetic penicillin steady against a penicillinase have advantage. At intolerance of penicillin Vancomycinum is shown. Prosthetics (replacement) of the damaged valve is effective. Depending on complications of a septic endocarditis (thromboembolisms, heart failure, etc.) apply also other means. The main objective of average medical personnel consists in careful observation and a nosotrophy, strict performance of medical appointments.