Endocarditis is a pathological process in which the inner lining of the heart is affected, as well as aortic and cardiac valves.
This disease is extremely dangerous not only for health, but also for human life. In case of delayed onset of treatment, the consequences can be most dire, including the development of heart failure, blockage of blood vessels of internal organs and the occurrence of immune diseases.
Endocarditis can have an infectious (bacterial) and non-infectious nature. And although it is often found the first type of endocarditis, there are cases of its development against the background of immunopathological processes and mechanical damage to the walls of the heart.
What is it in simple words?
The endocardium is the inner lining of the heart, during inflammation of which a disease called endocarditis develops. The acute form of the disease is often not an independent disease - this is just one of the manifestations of other pathological processes occurring in the patient's body.
About endocarditis, as an independent disease, they say only in the case of its subacute course. In such a situation, it is often caused by streptococcal infection.
The disease occurs in people in all countries of the world, without exception, and most often it develops in men. The incidence is 3.1–11.6% per 100,000 inhabitants.
In recent years, endocarditis affects the elderly more and more. So, if in developed countries this pathology was sick for people of 35-40 years old, today patients suffering from it are older than 50. At the same time, there is a risk of endocarditis developing in young children. This is especially true of children who have had congenital heart defects.
The mortality rate from this disease varies in the range of 15-45%.
Causes of the disease
The type of endocarditis depends on whether it was caused by a bacterial infection, or developed under the influence of other diseases.
So, infective endocarditis can be:
The most common is bacterial endocarditis, which develops under the influence of pathogens that can get on the inner lining of the heart through the blood from:
- purulent rash on the body;
- sore or filled with purulent congestion of the tonsils;
- teeth affected by caries;
- organs of the respiratory system (with the infectious nature of the existing disease).
Pathology of the genitourinary sphere, as well as the introduction of infection during the process of prosthetic heart valves can also cause the development of bacterial endocarditis.
The development of non-infective endocarditis often occurs under the influence of autoimmune diseases. In this case, the human body begins to produce autoimmune antibodies, which attack not alien, but healthy, pathologically unchanged, cells. As a result, aseptic endocarditis develops, which, in turn, can lead to valvular heart disease.
One of the common causes of non-infective endocarditis is rheumatism. This disease, which has an allergic nature, and often develops against the background of a sore throat, caused by green streptococcus. In the advanced stage of tonsillitis, damage to the heart tissue occurs, and the endocardium suffers primarily from the pathological process.
The development of endocarditis is not the last influence and transferred angina streptococcal etiology. These microorganisms produce a specific M-protein, due to the penetration of which into the blood, an acute autoimmune reaction of the body to the connective tissue occurs. And although streptococci do not actively participate in the development of inflammatory processes in the area of the endocardium, nevertheless, endocarditis after undergoing a course of therapy for tonsillitis is not a rare phenomenon.
The development of endocarditis in young children requires special attention. Pathology can be either congenital or acquired.
Thus, congenital endocarditis is a consequence of infectious diseases of the pregnant woman. The reasons for the acquired form of pathology can be the same factors as in adults.
Certain conditions are necessary for the development of endocarditis, which are often associated with the prolonged effect of the infectious agent on the endocardium. So, in this case, tonsillitis, furunculosis, periodontitis, etc. can lead to the pathological process.
The causes of acquired endocarditis include the penetration of a bacterial infection into the blood due to:
- surgical interventions in the area of various internal organs;
- tooth extraction;
- inserting a catheter into a vein or bladder, etc .;
- intravenous drug administration, etc.
The pathological process is often localized on those heart valves that were previously subject to changes due to congenital, rheumatic lesions of the heart, or after a patient's prosthetic heart valves. The following valves are most often affected:
In this case, the tricuspid and pulmonary heart valve is most often affected by injecting drug users.
The basis of the pathological process is considered destructive-ulcerative endocarditis, accompanied by thromboembolic overlays. They subsequently lead to the development of thromboembolism.
In addition, autoimmune mechanisms of the body are directly involved in the development of endocarditis. A blood test reveals a large amount of antibodies to certain representatives of pathogenic microflora. Circulating immune complexes that can lead to the development of vasculitis or glomerulonephritis are also detected.
Endocarditis in origin occurs:
- primary, when the pathological process develops in the field of absolutely healthy valves;
- secondary, developing on previously modified heart valves (due to congenital malformations, rheumatism, etc.).
According to the classification of the clinical course of endocarditis is:
- Acute, the symptoms of which persist for 1-2 months. Common causes of this form of endocarditis are sepsis caused by streptococcal microflora, injuries, and therapeutic or diagnostic interventions in the heart area.
- Subacute. This phase can last 2 months or more. Develops against the background of untreated acute endocarditis.
- Chronic, prone to relapse. The clinical picture of this form of endocarditis may persist for six months. Chronization of the pathological process can occur against the background of a deep lesion of the myocardium, or in violation of the functions of the valvular apparatus.
Chronic endocarditis is often found in newborn babies and toddlers with congenital heart defects. This form of the pathological process is also widespread among drug addicts and patients undergoing surgery.
Clinical manifestations of endocarditis are directly dependent on its type. They can grow and subside, replace each other or manifest all together.
For acute endocarditis is characterized by the presence of:
- febrile or pyretic fever;
- severe chills, which is particularly acute with increasing body temperature;
- joint and muscle pain;
- physical weakness, lethargy;
- a grayish or yellowish skin tone (sometimes with red spots on it);
- painful nodules localized on the fingers of the upper limbs;
- hemorrhage in the conjunctiva.
For subacute infective endocarditis is characterized by the occurrence of the following symptoms:
- febrile fever;
- sleep disorders;
- trembling through the body;
- unreasonable weight loss;
- the acquisition of the skin coffee and milk shade;
- the appearance of a red rash all over the body;
- the occurrence of subcutaneous small painful nodules.
The chronic form of endocarditis is characterized by the same clinical manifestations that can last for 6 months or more. During this period of time, there is a significant decrease in body weight, and the patient's fingers acquire a hue of drum sticks. Nails become dull and fragile, begin to exfoliate and break. Numerous hemorrhages appear under the nails, and painful plaques form on the skin of the hands and feet.
The development of heart disease, first of all, is indicated by shortness of breath. At first, it manifests itself during physical exertion, but over time it also appears in a state of absolute rest. The patient is disturbed by pain behind the sternum, the heart rate rises. The patient's body temperature has no effect on these anomalies.
With the development of glomerulonephritis or kidney infarction, primarily on the face of the patient, edema is formed. Then there is a violation of the process of urination, decreases the amount of secreted daily urine. Urine becomes reddish, acquires an unpleasant smell, and this process is accompanied by fever and intense back pain.
Pulmonary thromboembolism is characterized by severe shortness of breath and a feeling of acute lack of air. The patient complains of pain behind the sternum. Against the background of oxygen starvation, the complexion becomes purple or bluish, serious disturbances in consciousness occur.
Symptoms of infective endocarditis develops in 3 stages:
- Infectious-toxic. At this time, the pathogens enter the bloodstream and "settle" on the heart valves. Rapidly multiplying, they form specific growths - vegetation.
- Infectious-allergic, when the activation of the immune system occurs in response to an attack of pathogenic microflora. When this occurs, damage to the internal organs: kidney, liver, myocardium, etc.
- Dystrophic. For this phase of endocarditis is characterized by the occurrence of severe complications. There is necrosis of the heart tissue and severe damage to many organs of internal secretion.
If endocarditis is of rheumatic nature, then it develops, as a rule, against the background of previous glomerulonephritis or tonsillitis, accompanied by the release of specific beta-hemolytic streptococcus. After attenuation of the symptoms of the pathological process, the patient complains of fatigue, weakness, general malaise and fatigue.
Then fever develops again - subfebrile or even febrile. The patient complains of pressure, stabbing or aching sensations in the heart area. Against the background of such a picture, other symptoms of rheumatism may appear: in particular, periodic enlargement of large joints, their soreness. These signs pass by themselves, but are prone to a new occurrence.
Danger and complications
The most common complications of endocarditis include:
- development of chronic heart failure;
- malformations or chronic inflammation of the heart valves.
Consider each of the situations in more detail.
- In chronic heart failure, the pumping and contractile function of the heart is significantly reduced. This deviation is due to damage to the myocardium and heart valves.
- Thromboembolism is one of the most dangerous complications of endocarditis. When a blood clot is torn off, it may be released into the pulmonary circulation, which, in turn, can lead to blockage of the pulmonary artery. The penetration of a blood clot into the large circle of the blood flow causes a disturbance of blood circulation in many internal organs and parts of the body: limbs, spleen, gastrointestinal tract, etc.
- Prolonged chronic inflammation. Prolonged exposure to pathogenic microflora with endocarditis can lead to the formation of multiple ulcers in the body. This, in turn, can cause the development of sepsis.
Often, with infective endocarditis, the development of renal and hepatic failure occurs. Other equally serious complications of pathology include:
- embologic heart attacks and strokes;
- inflammatory processes in the tissues of the lining of the brain;
- the formation of intracranial ulcers;
- thrombosis, etc.
In severe cases, death is possible.
In order to make sure that the diagnosis is correct, the doctor, first of all, collects anamnesis. When interviewing a patient, he reveals his tendency to cardiovascular diseases, carefully studying the patient's symptoms and the frequency of its manifestations.
Of great importance in the diagnosis is auscultation and percussion of the heart area. As a result of inflammation, there is a violation of the organ, which fixes the doctor when performing these manipulations.
Based on the data obtained, the cardiologist concludes that it is necessary to carry out instrumental and laboratory diagnostic procedures:
- Deployed blood count. With endocarditis, an increase in ESR and an increase in the level of leukocytes is observed.
- Bacteriological examination of venous blood, which is carried out three times. It is necessary to determine the specific type of pathogenic microorganisms for suspected infectious nature of endocarditis.
With the help of the last two procedures, the presence of vegetations in the heart area, as well as its structural changes, are revealed.
Treatment of infectious and non-infective endocarditis
In case of a relatively mild course of infective endocarditis, antibiotic therapy is practiced; in severe cases, surgical excision of inflamed heart tissue is practiced. If there is a heart defect, all the efforts of doctors should be directed at correcting the functioning of the organ.
Antibiotics for treatment infective endocarditis appointed exclusively by a doctor! The course of therapy lasts from 4 to 6 weeks. Often prescribed combined antimicrobial agents to achieve a more pronounced and rapid result of treatment. In addition to antibiotic therapy, fortifying treatment is carried out. It is based on the use of immunoglobulins, anti-infective drugs and hormonal agents from the GCS group.
If a endocarditis is non-infectiousp, then its treatment depends on the specifics of the underlying disease. In case of endocrine system pathologies, it is necessary to pass a blood test from a vein to determine the level of hormones. If abnormalities are found, the patient will need to undergo a course of therapy from an endocrinologist.
Endocarditis caused by alcohol intoxication or poisoning by harmful substances is treated by refusing or eliminating contact with the toxin.
The operation for endocarditis is the excision of the affected areas of the heart valve with their subsequent prosthetics. If there is a possibility of plastic surgery, then there is no need to replace the natural valves with artificial valves.
After discharge from the hospital, the patient must undergo an additional course of outpatient monitoring.For six months, he will have to visit the clinic every month for regular check-ups with a doctor who will evaluate the effectiveness of the therapy and the risk of recurrence of the pathology. After this, medical examinations will be held twice a year.
Prediction for life
The prognosis of life after endocarditis is conditionally unfavorable. Even with the use of broad-spectrum antibiotics, patients die from severe complications in 30% of cases. However, timely antibiotic therapy increases the patient's chances of complete cure and restoration of efficiency.
Endocarditis relapses occur 4 weeks after the treatment. They can occur due to improperly chosen antibiotics or the inexpediency of their use. A repeated outbreak of the disease leads to severe damage to the heart valves, and also increases the risk of developing heart failure.
To prevent the development of endocarditis, you must:
- timely identify and cure infectious diseases: caries, tonsillitis, bacterial pathology of the roto-and nasopharynx;
- regularly conduct prophylactic antibiotic therapy in persons who are at risk;
- avoid stress;
- give preference to moderate physical exertion;
- time to treat viral diseases;
- strengthen the immune system;
- immunize the CCP.
Patients with previous endocarditis should undergo regular preventive medical examinations. Well help to restore the body spa treatment courses.
And most importantly: that the disease no longer reminded of itself, a person should be attentive to their health. If any disturbing symptoms appear, you should discard the idea of self-treatment, and contact a competent medical specialist.
Which doctor to contact?
Endocarditis is treated by a cardiologist. But in some cases, the patient may be referred for additional consultation with other specialists:
If rupture of the spleen has become a complication of endocarditis, the patient is referred to a surgeon. If necessary, prosthetic surgery of affected valves requires the intervention of a heart surgeon.