Infective endocarditis: symptoms, diagnosis, treatment

Causes of infective endocarditis

Infectious endocarditis can be caused by various bacteria and microscopic fungi, the biological properties of which allow them to grow and multiply by attaching to the tissues of the heart.

Infective endocarditis is one of the most dangerous cardiac diseases. Mortality even with intensive treatment in a specialized hospital is very high (according to various sources, from 15 to 25%). And if endocarditis is not treated, it is guaranteed to “eat” the heart valves, blood circulation will become impossible and the patient will die.

Routes of infection

The first way is infection of the natural “channels” leading into the body - skin, teeth, urinary tract, female reproductive system. The entry of a microorganism into any blood vessel gives it a chance to travel through the bloodstream to the heart.

The second way is artificial. Any violation of the integrity of the skin and mucous membranes (usually with the help of medical instruments or needles) can lead to infection entering a blood vessel. Hence the increased incidence of infective endocarditis in drug addicts and patients who have undergone various types of surgical interventions - from tooth extraction to operations to replace heart valves. It is clear that the greater the volume of intervention, the higher the potential threat of infection. In this regard, during surgical interventions one or another antibiotic prophylaxis regimen is used.

Symptoms

The disease may develop asymptomatically for some time. It is also characterized by acute and chronic stages. There is an extensive list of symptoms, which makes it difficult to make a correct diagnosis.

The clinical picture of endocarditis is expressed in the following symptoms:

elevated temperature;
chills;
sweating;
enlarged lymph nodes;
signs of intoxication (weakness, headaches);
change in skin color (pallor, spots);
changing the shape of nails;
arthritis of large joints;
damage to the heart valves;
increased thrombus formation;
signs of pericarditis;
systemic damage to organs (kidneys, central nervous system, etc.);
progressive heart failure.

The manifestation of the disease is individual and depends on the general condition of the patient’s body and the severity of the pathological process.

Clinical picture of the disease

The clinic of infective endocarditis is formed by three components.

The first is septic (when any infection enters the bloodstream, a high temperature, severe weakness, increased heart rate, and disorders of the blood coagulation system develop).

The second component is the manifestation of local infection. Microorganisms form colonies on the inner lining of the heart, most often on the valves - the so-called vegetations. Vegetations can be detected by ultrasound examination of the heart. Sometimes they are not visible with conventional echocardiography, and then an ultrasound examination through the esophagus (similar to gastroscopy, only with a special ultrasound probe) is necessary for diagnosis.

The third component is the consequences of the separation of vegetations from the valves - blockage of blood vessels by vegetations (embolism). Pieces of vegetation can “fly away” into any blood vessels - the brain, heart, kidneys, limbs, lungs, causing the death of the corresponding tissues due to impaired blood flow, which is accompanied by clinical manifestations of damage to a specific organ.

If a patient with a high temperature (fever) of unknown origin lasting more than a week, which does not respond to conventional treatment with antibiotics, has additional symptoms (heart murmurs or disturbances in organs into the vessels of which a torn piece of vegetation has “flown”), examination for the presence of infective endocarditis is necessary .

Magazine archive /
2010 /

Kidney damage and disturbances in the hemostatic system in subacute infective endocarditis

A.A. Demin, V.P. Drobysheva, E.S. Friedman
Department of Hospital Therapy and Clinical Pharmacology, Faculty of Medicine, State Educational Institution of Higher Professional Education “Novosibirsk State Medical University”, Novosibirsk

Purpose of the study. To determine the features of kidney damage (RD) and the role of disturbances in the hemostatic system in the development of RP in subacute infective endocarditis (IE). Material and methods. In 120 patients with subacute IE, blood, urine, serum creatinine levels, parameters characterizing the hemostatic system were examined, and blood and urine cultures were performed. We performed two-dimensional transthoracic and transesophageal echocardiography, color Doppler blood flow mapping, and ultrasound examination of the kidneys. Results. PP was observed in 77% of patients with subacute IE. Changes in urinary sediment were noted in 90.3% of patients, hematuria in 87%, proteinuria in 50%, and leukocyturia in 55%. Chronic renal failure (CRF) developed in 33.3% of patients. Ultrasound examination revealed signs of renal infarction (RI) in 10% of patients. An analysis of 10 fatal cases of subacute IE with PP showed that all deceased patients had glomerulonephritis (GN), more often mesangiocapillary; 6 have IP. In 43 (46.2%) patients, PP was combined with severe hemostasis disorders. Correlation analysis revealed a connection between the parameters of urinary sediment and the hemostatic system. Conclusion. Kidney damage in subacute IE is characterized by the development of urinary syndrome with moderate hematuria, leukocyturia, and proteinuria. Renal failure is a common complication of subacute IE. The most common morphological variant of GN in IE is mesangiocapillary. In subacute IE with kidney damage, more pronounced disturbances are observed in all parts of hemostasis, which is confirmed by data from laboratory research methods. The degree of disturbances in the hemostatic system correlates with the severity of changes in urinary sediment. With an increase in the degree of activity, the role of the vascular component decreases and the importance of disorders of the coagulation component of hemostasis in the development of kidney damage in subacute IE increases.

Key words: disorders in the hemostatic system, infective endocarditis, kidney damage

Read the article in the Doctor's Library

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About the authors / For correspondence

Demin A.A. – Professor, Head of the Department of Hospital Therapy and Clinical Pharmacology, Faculty of Medicine, State Educational Institution of Higher Professional Education “NSMU”, Doctor of Medical Sciences. Email; Drobysheva V.P. – Professor of the Department of Hospital Therapy and Clinical Pharmacology of the Medical Faculty of the State Educational Institution of Higher Professional Education “NSMU”, Doctor of Medical Sciences. Tel.; Fridman E.S. – Assistant at the Department of Hospital Therapy and Clinical Pharmacology, Faculty of Medicine, State Educational Institution of Higher Professional Education “NSMU”, Ph.D. Tel.

Diagnosis of infective endocarditis

An accurate diagnosis of endocarditis is made by positive blood culture results and reliable visualization of intracardiac vegetations. In all other cases, the diagnosis of endocarditis is made with varying degrees of probability.

The following types of research are used:

Laboratory diagnostics;
Electrocardiography (ECG);
Echocardiography;
X-ray of the chest organs.

1 Consultation with a MedicCity cardiologist

2 ECG as a method for diagnosing infective endocarditis

3 Full description of the picture

Prevention

Preventive measures to prevent endocarditis include giving up bad habits, paying close attention to health, and timely treatment of emerging infections.

If you have a chronic form of the disease, you should regularly visit a cardiologist and undergo examination.

Endocarditis is a serious heart disease that can occur in both children and adults. Therefore, if your health condition worsens, it is necessary to seek help from a qualified specialist as soon as possible. At the medical center you can undergo a full examination of the body in the shortest possible time. Based on the clinical picture, the doctor will make a diagnosis and prescribe effective treatment.

Treatment of infective endocarditis

Treatment for infective endocarditis begins with high doses of serious antibiotics, usually intravenous. Treatment continues, depending on the specific type of pathogenic microorganism, from two to six weeks. If treatment is ineffective (high temperature, further growth of vegetations according to echocardiography), a decision is made on surgical treatment (the heart is opened, vegetations are cleaned out, and, if necessary, the affected valve is replaced with an artificial one). However, as previously described, treatment is not always successful, and despite medical advances, the mortality rate of infective endocarditis has not been significantly reduced.

Measures to prevent infective endocarditis

If you need any surgical intervention (from tooth extraction to abdominal surgery), be sure to ask your doctor if any action on your part is needed for antibiotic prophylaxis for infective endocarditis (sometimes preventive antibiotic therapy is already included in the hospital treatment plan). If the doctor gives recommendations for taking antibiotics at home, be sure to follow them.

If you accidentally slightly damage the skin (cut), be sure to treat the wound with an antiseptic (alcohol, brilliant green or iodine). If the cut or puncture is deep, you should immediately take an antibiotic (for example, if you are not allergic to penicillin, Augmentin 1 gram once).

At MedicCity you can undergo a comprehensive cardiological examination and treatment of identified cardiovascular diseases. Reception is carried out by highly qualified cardiologists using expert equipment.