Endocarditis

Endocarditis is an inflammation of the endocardium. Usually endocarditis occurs as a manifestation of a General disease; often origin distinguish rheumatic and septic endocarditis, in addition, endocarditis sometimes syphilis, tuberculosis, trauma, myocardial infarction and other etiology.
Most often when endocarditis affects the heart valves, at least - parietal the endocardium cavities of the heart. Anatomical changes of the endocardium depend on the form of endocarditis. Rheumatic endocarditis affected endothelium heart valves with the subsequent imposition of thrombotic masses and the growth of granulation tissue. At the heart valves appear education, similar to warts (warty endocarditis). For septic endocarditis is characterized by ulcerative lesions of the heart valves (ulcerative endocarditis) and the formation of blood clots in the damaged endocardium; often there is destruction of the heart valves. After any form of endocarditis may remain persistent changes in the structure of the heart valve which alter their function, i.e. developing heart disease.
The clinical picture of endocarditis depends on its cause. Rheumatic endocarditis can be combined with other forms of rheumatism (see). He gradually begins. Appear weakness, malaise, low grade (sometimes high) temperature, heart rate and unpleasant feelings in the heart, shortness of breath during physical activity. In the study hearts find its expansion, often listen to the noises: systolic and later and diastolic (see, see Diastolic murmur, Systolic murmur). Pulse labile, more accelerated.
Septic endocarditis may be subacute and acute. It is caused by Streptococcus, rarely Staphylococcus, pneumococcus or other microbes that are circulating in the blood, settle on the valve and cause inflammation. Easier develops septic endocarditis on previously damaged valves (rheumatic and congenital heart disease).
More often septic endocarditis occurs subacute - the so-called protracted septic endocarditis (Endocarditis septica lenta). The patient appear weakness, unpleasant feelings in the heart area. The temperature initially subfebrile with rare rises to 39 degrees; later appears feverish with large temperature fluctuations during the day, accompanied by chills and torrential sweats, anemia. Skin becomes pale yellowish tint. Fingers often take the form of drum sticks. Pulse Ochsen. Heart size increased; auscultation it is often heard noises; if earlier the patient has had a heart defect, the nature of noise, listen auscultation of the heart, changed. Most often develops failure of the aortic valve. Marked enlargement of the spleen, the defeat of blood vessels: the capillaries become fragile, there are hemorrhages in the skin and mucous membranes. Characteristic of bleeding in the lower eyelid conjunctiva (the symptom Lukin). Septic endocarditis may be complicated by embolism (see) in vessels of the brain, kidneys, spleen and other organs; the emboli are particles of blood clots or destroyed valves. Usually develops nephritis (see). In the blood is reduced number of red blood cells and hemoglobin content, often increases the number of monocytes, appear histiocytes (positive sample Bittorf - Tushino). Changes the ratio of protein whey of blood by increasing gamma-globulin. ROHE accelerated. Often blood sow pathogen (often viridans streptococci). In urine appear protein, erythrocytes, cylinders.
Acute bacterial endocarditis is rare. The clinical picture it complies with acute sepsis (see). The General condition of patients with severe: high fever, chills, sweats. Develops sharp anemia. In the study of the heart are increasing, listen to the noise.
The prognosis depends on the etiology of endocarditis and timing of treatment. Subacute endocarditis, caused viridans or non-haemolytic streptococcal, cured in 90% of cases, and Enterococcus or Staphylococcus - more than 50% of cases. Endocarditis is the most frequent cause of heart defects (see). Forecast in old age is always harder.
Treatment of endocarditis out in a hospital. Treatment of rheumatic endocarditis - see Rheumatism. In septic endocarditis long-term use of large doses of antibiotics (it is reasonable to determine the sensitivity to them agent). Intramuscularly penicillin not less than 4 000 000 IU per day (administered every 4 hours), combining it with streptomycin (500,000 UNITS, 2 times a day) or with other antibiotics: tetracycline (4 000 000 IU a day inside), erythromycin (3 000 000 UNITS inside); apply signalizing, which is injected intravenously every 4 hours up to 4 000 000 IU per day. As temperatures drop in two weeks, the dose of antibiotics gradually reduced, but a break in treatment do not earlier than in 5-6 weeks. Repeat treatments. In addition to antibiotics, and anemia prescribe iron supplements, multivitamins, with circulatory failure - heart glycosides. Patients must stay in bed until the complete elimination of the inflammatory process in the endocardium. Feed patients 4-5 times a day in small portions. Food should be easy to digest, salted, rich in vitamins. Patients with endocarditis need careful maintenance. You need to monitor the cleanliness of the skin, intestinal function. The chamber must often be aired.
Prophylaxis of endocarditis include prevention of rheumatic fever, sepsis and other diseases, against which it occurs. Of great importance are the activities that increase the body's resistance (hardening, physiotherapy and other), treatment foci of infection (carious teeth, tonsillitis, sinusitis and others). To prevent the recurrence of endocarditis should dispensary observation of persons undergoing endocarditis.

Endocarditis (endocarditis - inflammation of the endocardium.
Most often affects the valves (valvola), sometimes parietal the endocardium of heart cavities, tendon threads, papillary muscles, trabeculae cameae. Clinically endocarditis is a disease of the whole body (for example, rheumatism, or sepsis), in which the defeat of the endocardium dominates. Endocarditis can have a poor prognosis in early disease (with septic endocarditis). Sometimes endocarditis very little change over the underlying disease (endocarditis during intoxication, cancer and so on).
Clinically, there are the following groups. I. Septic (bacterial) endocarditis: 1) acute, 2) subacute. II. Rheumatic endocarditis: 1) acute primary, 2) return, 3) latent, 4) healed scar. III. Endocarditis different etiology: 1) syphilis, 2) tuberculosis, 3) traumatic (postoperative), 4) thromboangiitis parietal (myocardial infarction, myocarditis), 5) valve bacterial thrombotic, 6) atypical verrucosus, 7) fibroelastosis parietal, endomyocarditis, fibroblasts parietal, endocarditis parietal.