Types of infective endocarditis and the principles of its treatment

Questions classification

Classification of infective endocarditis provides for the allocation of origin of the two forms of the disease:

• primary endocarditis appears on healthy valve apparatus;
• secondary occurs against a background of existing heart disease congenital nature, as well as rheumatic, syphilitic, tuberculous, as a result of arteriosclerosis and injuries of the heart.

The second group includes post-infarction endocarditis, a disease caused by a tumor of the heart, prosthetic valves.

As complications of valve replacement endocarditis are possible:

• in the early stages (within one month after the surgery);
• late manifestation (two months to six months).

The clinical course has a unit of forms:

• acute infective endocarditis — occurs as a result of septic conditions;
• subacute form — as a kind of sepsis associated with intracardiac infectious lesion on the background of rheumatism, inflammation of kidneys (glomerulonephritis). Develops by embolism of bacteria that are not too strong ability to infected tissues. In this form is insufficient for acute lesions reduced levels of immunity.

There is disagreement about the term "chronic infectious endocarditis". Many scientists believe it is the result of prolonged improper treatment, late diagnosis.

Clinical manifestations of acute septic endocarditis

Acute sepsis can occur as a result of local purulent foci, infected wounds, strep throat, postpartum post-abortion endometritis. In some cases, the primary lesion can be found.

In place of the introduction of an infectious agent going the endothelial cells aggregate platelets, form blood clots. They are of a warty character growths (polyps) or soften and break away, leaving in its place ulcers. Of the products of disintegration of blood clots form emboli, which are carried from the heart to the various organs.

In the clinic there are General symptoms of sepsis, and immediate symptoms, indicating the criteria of infective endocarditis.

Infective endocarditis in children most often occurs in the age group of up to ten years. The disease poses a serious risk to the life of a child. The mechanism of development and the reasons are not different from those in adults. The greatest number of lesions accounts for the aortic valve, and then are involved in the process other valves of the endocardium.

The acute form is entirely obscured by symptoms of sepsis.

For subacute course characterized by prolonged elevation of the temperature to a low level, joint pain, sweating.

Diagnosis

In the diagnosis of infective endocarditis has a valuecomparison of symptoms of sepsis with previous interventions or diseases, speed surveys and compare results over time.

1. In the blood: the high leukocytosis with a significant shift formula to the left at the expense of band forms, the drop in the number of red blood cells, sharply accelerated ESR.
2. Bacteriological analysis enables to sow from the blood of pathologic microorganisms. Sampling analysis is taken at least three times to improve the reliability of the results.
3. On ECG — sinus tachycardia, extrasystoles possible, reducing the height of the teeth.
4. A cardiac ultrasound allows to detect the lesions of the valve apparatus.
5. An important additional symptom is the manifestation of embolic complications of cerebral vessels, eyes, spleen, heart, abdominal cavity.