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Infective endocarditis - Causes, Treatment
Infective endocarditis - Causes, Treatment
The heart is a hollow muscular organ. Its wall consists of three layers:
outer layer - the pericardium - a thin sheet of connective tissue
medium - the myocardium - the muscular layer
internal - endocardium - a piece of connective tissue lining the cavity of the heart valves and forming it.
Infective endocarditis (an inflammatory disease of the heart) - is an infectious-inflammatory disease that affects the endocardium, heart valves, the lining of blood vessels nearby. The same infection can cause a simultaneous kidney disease, liver and spleen. Before the advent of antibiotics, most patients with infectious endocarditis died of infection and its complications. Now, more than 80% successfully cured. But almost 20% of drug treatment is ineffective, and soon they have a heart failure, which is almost impossible to treat. For the treatment of such patients apply surgical techniques.
The incidence of infective endocarditis increases around the world. This is due to the fact that the infection occurs more easily than on the healthy and pathologically altered valve or endocardium. The risk groups include patients with atherosclerotic, rheumatic, traumatic injuries of the valves. In recent years significantly increased the number of patients with mechanical and biological prosthetic valves, artificial pacemakers. The number of people who develop infective endocarditis due to continuous intravenous infusions. Very often suffer from drug addicts.
The causes of endocarditis.
Previously, the main cause of infective endocarditis were Streptococcus spp. This infection is well to treat. In our time, in connection with a wide range of antibiotics of microbial pathogens has changed. Now infective endocarditis caused staphylococci, Pseudomonas aeruginosa, fungal microorganisms. Diseases caused by these pathogens is more severe, especially endocarditis caused by fungal infection. Most infection occurs locally prosthetic valve. This is called a prosthetic infective endocarditis develops within two months following surgery for prosthetic heart valve. In this case, the causative agent of the disease is most often Streptococcus. The high risk of developing endocarditis are those with heart disease, especially aortic valve defect, ventricular septal defect, coarctation of the aorta.
However, infective endocarditis can get sick and healthy people. This is facilitated by physical and mental stress, low immunity. In order to reach the valve to reach the microorganism in the blood. Since microbes are constantly facing the people. It is proved that even with normal brushing a small amount of bacteria in the blood. But this does not mean that everyone gets sick, who brushes his teeth. Current micro-organism enters the blood to the heart, and if the heart valves are damaged, it is easy to stick to it and begins to multiply, creating a colony of microorganisms, the so-called microbial growth. Microbial vegetation can quickly destroy the valve.
The valve can break away pieces of wings or colonies of microorganisms can be torn wing. Pieces of the valve or bacterial vegetations on the flow of blood can enter the brain and cause heart attacks the brain, accompanied by paralysis, paresis or other neurological disorders. Ruined the valve can not perform its function, and soon there is heart failure. Heart failure is progressing very quickly, because the heart does not have time to use their compensatory possibilities.
Classification of endocarditis.
Distinguish infective endocarditis active and inactive (healing).
Surgical classification:
damage is limited to the valve flaps damage extends beyond the valve.
Course of the disease.
In the classical course of infective endocarditis in a patient appears high body temperature, chills, weakness, shortness of breath, sweating, weight loss, cough, skin rash, vomiting, chest pain, "drumsticks." Now many patients with no rash, many of the temperature may be normal. When listening to the noise detected over the area of the heart reveal an enlarged spleen, lesions of the retina, inflammation of the kidneys. In the blood, detect inflammatory changes. To clarify the diagnosis determine the presence of a microorganism in the blood. To do this, take blood from an artery. In infective endocarditis microorganisms are always found in the blood. They get back to the heart valves. On the echocardiogram can be seen microbial vegetation larger than three millimeters to the heart valves. In 80% of cases with echocardiography established the diagnosis.
Treatment of infective endocarditis.
There is no direct answer to the question of medication to treat a patient, or to operate. The operation in terms of microbial destruction is dangerous. But after prolonged ineffective medical therapy may be heart failure, which has no cure. So first of all, treat the infectious process, but under constant control of the heart. Regularly repeated blood cultures, an electrocardiogram and an echocardiogram.
Surgical treatment is carried out:
the development of heart failure
long-term detection of microorganisms in the blood in spite of the antibiotic
fungal endocarditis.
With the development of severe heart failure without surgical mortality reaches 60%, and in lesions of the aortic valve - 80%. The operation must be carried out at the first sign of heart failure. If the infectious process is treated well, but valvular require treatment, the question of surgery solved routinely.
