INFECTIOUS ENDOCARDITIS: diagnosis, clinical course, treatment

Among heart diseases, endocarditis is one of the most insidious. Under the influence of various infections (there are about 130 causative agents of this disease), the inner lining of the heart becomes inflamed. The danger is that the symptoms of infective endocarditis do not appear immediately, so patients do not always seek help in a timely manner. Also, the disease is not easy to diagnose, which is why treatment may be started later than expected. That is why cardiologists recommend regular examinations in medical centers equipped with modern equipment that has extensive research capabilities.

What is endocarditis

Symptoms of the disease occur in people of different ages, including children diagnosed with “congenital heart defects” (tetralogy of Fallot, single ventricle defects, etc.). It can be provoked by:

• mitral valve prolapse;
• hypertrophic cardiomyopathy;
• surgery on heart valves;
• cardiac septal defects;
• coronary heart disease (especially after surgery).

The disease is primarily infectious. Inflammation caused by microorganisms affects not only the endocardium itself - the internal tissues of the heart muscle - but also the heart valves and nearby vessels. Often the infection penetrates the liver, kidneys, and spleen.

Most often, pathology becomes a consequence of other diseases. The prerequisites for the occurrence of infective endocarditis is bacteriological infection of the body under various conditions. The infection also affects the heart when its valves are injured due to the installation of prostheses and pacemakers, on the surface of which microorganisms can develop. There are atherosclerotic forms caused by dystrophic changes in cardiac tissue, and rheumatic forms - due to rheumatism of the heart valves.

Preventive actions

Endocarditis is one of the few heart diseases whose development can be prevented. Doctors give the following recommendations:

1. Treat any infection in a timely manner, even if it is a simple sore throat. Under no circumstances should you “carry it on your feet.” Bed rest, taking medications and traditional medicine will reduce the load on the heart.
2. If you experience even slight discomfort in the chest area and shortness of breath during physical activity, you should visit a cardiologist and undergo an examination. When endocarditis is detected at an early stage, recovery occurs in 98% of cases.
3. If there is a history of any heart disease, including congenital defects, mandatory medical examinations with a special examination are recommended. Prevent pathogenic bacteria and infectious agents from entering the body. Be sure to strengthen your immune system.

More information about how you can avoid the development of inflammation of the inner lining of the heart and how rheumatic endocarditis is prevented can be found on our website.

Related services: Cardiological Check-up Complex cardiac surgery (simple)

Classification and causes of endocarditis

In accordance with the causes and clinical manifestations, the disease is classified as follows.

Infectious (bacterial) endocarditis most often manifests itself in an acute form. Ulcers and polyps form on the heart valves or in the heart tissues, which lead to functional disorders.

The chronic or subacute form is usually caused by streptococci. The disease is manifested by ulceration and changes in the shape of the heart valves, the formation of blood clots in the vessels, followed by blockage. The consequences may be inflammation of the kidneys and heart attacks of other organs.

A non-infectious disease occurs against the background of a general weakening of the body, with various intoxications, and in older people with the development of marasmus. Among the forms are degenerative warty, abacterial, etc. Most often it manifests itself in the form of thrombotic deposits on valve tissue.

Rheumatic endocarditis , as the name suggests, occurs due to rheumatism. In this case, inflammation spreads to the heart valves and causes heart defects. There are 4 forms: diffuse, acute warty, recurrent warty, fibroplastic.

Loeffler's endocarditis is characterized by an increase in blood eosinophils and a decrease in the volume of the heart chambers due to fibrous changes in the endocardium and then the myocardium. There are three stages: acute (cell death within 5-6 weeks), thrombotic (formation of blood clots and atrophy of some tissues), fibrosis (sclerosis and thickening of the endocardium).

Infectious (bacterial) endocarditis

In the acute form, the symptoms of bacterial endocarditis develop quite quickly. Typically, the infection affects the lining of the heart valves, 2-10 mm ulcers appear on the tissues of the valves, and the valves themselves swell - platelets and fibrin accumulate, and aneurysms form. As a result, one of the large vessels may become blocked by a blood clot, and valve particles may come off. In some cases, septic infarction cannot be excluded.

If you do not seek qualified help in time and do not start treatment:

• heart failure develops;
• the structure of valves and leaflets is deformed;
• arrhythmic phenomena appear;
• hemodynamics are impaired.

Patients with subacute septic endocarditis are characterized by the same manifestations of pathology, but in this case, most often the tissues are affected by thrombotic formations, which sooner or later clog one of the most important vessels.

Inflammatory heart diseases - pericarditis

Pericarditis - what is it? Inflammation of the pericardium, the serous membrane of the heart; occurs most often as a complication of one or another disease, less often as an independent disease. The causes of pericarditis are as varied as with other inflammatory heart diseases. In principle, infectious (bacteria, viruses, protozoa and even some types of fungi) and non-infectious (connective tissue diseases, tumors, injuries, post-operative) are distinguished. In form - acute (dry, exudative, with or without cardiac tamponade) and chronic. Pericarditis is manifested by an increase in the volume of fluid in the cavity of the pericardial sac or the formation of fibrous strictures that impede the functioning of the heart.

Pericarditis: symptoms

There are no specific symptoms of pericarditis; in the acute process, heart failure develops. Pericarditis usually causes pain in the chest and left arm, vaguely reminiscent of myocardial infarction, but on the ECG with pericarditis, sufficient R amplitude remains, there is no pathological Q wave, changes concern the final part of the ventricular complex (ST segment and T wave). In addition to pain, there are complaints of shortness of breath, palpitations, general weakness, weight loss, a dry cough may develop, in severe cases - hemoptysis, a feeling of heaviness in the right hypochondrium, an increase in abdominal circumference (a consequence of the progression of heart failure). Acute dry pericarditis often occurs suddenly - with a sharp increase in temperature, stabbing pain in the heart area, and a feeling of heart failure. Exudative pericarditis can develop gradually; the more fluid accumulates in the pericardial sac, the more pronounced the symptoms of pericarditis are: swelling of the neck veins, swelling in the legs, cyanosis of the face, suffocation, swallowing disorders, ascites (accumulation of free fluid in the abdominal cavity), tachycardia .

Pericarditis: diagnosis

If there is any suspicion of cardiac dysfunction, you should urgently consult a specialist. Cardiologist

can make a presumptive diagnosis already during a physical examination.
Auscultatory confirmation of the diagnosis will be the absence or displacement of the apical impulse and percussion expansion of the borders of the heart, muffled heart sounds or pericardial friction noise (with dry pericarditis). Instrumental diagnostics - ECG
,
echocardiography
- will allow you to verify the diagnosis. Pericardial diseases are dangerous, so it is unacceptable to self-medicate or drink “something for the heart.” Without correct and quick diagnosis of the disease, serious consequences are possible.

Pericarditis: treatment

Treatment of inflammatory heart diseases is carried out under the supervision of a doctor, usually in a hospital. Only in some mild cases, outpatient treatment is acceptable. The priority direction of therapy for pericarditis is treatment of the underlying disease. Diuretics may be prescribed to reduce the volume of fluid in the pericardium. If there is a threat of tamponade (compression of the cavities of the heart), a percutaneous puncture is performed and the contents are evacuated. Treatment of compressive (constrictive) pericarditis is only surgical.

Risk factors for developing pericarditis

The development of inflammatory diseases of the serous membrane of the heart is provoked by:

• rheumatism;
• systemic autoimmune diseases;
• severe pneumonia;
• chronic renal failure;
• tuberculosis, brucellosis;
• tendency to allergic reactions.

Prevention of inflammatory heart diseases

Primary prevention of most inflammatory heart diseases consists of two simple rules:

• increasing the body's resistance to infections (hardening, healthy lifestyle);
• timely treatment of focal infections (tonsillitis, caries, sinusitis, furunculosis, etc.).

Secondary prevention of inflammatory heart diseases consists of preventing relapses of the disease, taking measures to monitor patients, and following the recommendations of the attending physician for the treatment of the underlying disease (if any).

Endocarditis in children

In children, the most common bacterial type of this disease occurs. The pathology is expressed by damage to the mitral and aortic valves, and then spreads to the internal cardiac tissues:

• the child experiences acute toxicosis;
• endocardial tissue becomes inflamed;
• myocardial damage occurs;
• blood vessels may become clogged;
• blood flow is disrupted.

Infectious endocarditis in children usually develops at a faster rate; inflammation can spread to other internal organs and lead to liver and kidney failure. Therefore, in this case, it is necessary to seek professional cardiac help as soon as possible.

Symptoms of endocarditis

The disease is characterized by an asymptomatic course at an early stage, as well as a sudden exacerbation against the background of a relatively healthy state. Symptoms of endocarditis in adult patients usually appear 10-14 days after infection:

• fever with chills, profuse sweating;
• the temperature may rise for several days;
• signs of intoxication appear: headache, weakness, exhaustion;
• the skin may acquire a pale, yellowish tint;
• rashes may be observed on the mucous membranes, feet, and palms.

These signs indicate the presence of an infection in the body, so you should immediately consult a doctor and begin treatment.

They are complemented by more characteristic symptoms of infective endocarditis in adults, which indicate the development of this particular disease:

• arthritic changes in joints;
• damage to the heart valves;
• thrombosis and blockage of large arteries;
• enlarged lymph nodes;
• kidney infarction and other lesions;
• rapidly developing heart failure;
• pericarditis.

These symptoms of endocarditis are identified during diagnostic procedures.

Inflammatory heart diseases - myocarditis

Myocarditis - what is it? Inflammatory damage to the heart muscle, which is manifested by impaired cardiac activity (excitability, conductivity and contractility). Most often it is of a viral nature (half of all cases of myocarditis). The disease affects middle-aged people (30–40 years old, slightly more often women). By origin, myocarditis is:

• rheumatic;
• infectious (viral, bacterial, etc.);
• allergic (medicinal, post-vaccination, transplant);
• for diffuse connective tissue diseases;
• due to exposure to physical factors (trauma, burns, exposure to ionizing radiation);
• idiopathic (unexplained nature) Abramov-Fiedler myocarditis.

The course of myocarditis can be acute, subacute, chronic (recurrent).

Myocarditis: symptoms and diagnosis

Symptoms of myocarditis are often associated with an infectious disease - ARVI, tonsillitis, etc. (in the background or shortly after it). The most common signs of the disease are malaise, weakness, fatigue, shortness of breath, palpitations, heart rhythm disturbances, sometimes discomfort and pain in the chest, and rarely, pain in the joints. In infectious myocarditis, symptoms of an infectious disease usually dominate (fever, increased body temperature, general signs of intoxication). The onset of myocarditis can be asymptomatic, with low-grade or normal temperature; palpitations, “interruptions” in the heart’s function, and shortness of breath are often noted. The severity of symptoms depends on the prevalence and severity of the inflammatory process. Without treatment, signs of heart failure will increase. It is necessary to urgently consult a medical specialist! Timely diagnostic studies ( ultrasound of the heart

,
ECG
, radiography) can reveal:

• increase in heart size;
• heart rhythm disturbances (tachycardia, less often bradycardia, various arrhythmias);
• intracardiac conduction disorders.

Diagnosis of myocarditis often requires an integrated approach. In addition to physical examination, the following are usually used:

• clinical and biochemical blood test;
• electrocardiography
  (ECG);
• echocardiography
  (ultrasound of the heart);
• chest x-ray
  ;
• isotope study of the heart;
• MRI of the heart;
• endomyocardial biopsy;
• cultures of blood and other biological fluids;
• comprehensive study of immunological parameters.

By contacting the Energo clinic for help, you will have the opportunity in one place to undergo all the tests necessary for the correct diagnosis of inflammatory heart diseases. You can make an appointment at the Energo clinic using the form on the website or by calling the phone number listed on the page.

How to treat myocarditis?

Mild myocarditis, which occurs without complications, can be treated on an outpatient basis. In more severe cases, hospitalization, mandatory bed rest, etiotropic, anti-inflammatory and symptomatic therapy are required. Etiotropic therapy - treatment of the infection that caused myocarditis (viral, bacterial, fungal, etc.), and maintenance therapy of the primary disease (rheumatism, SLE, thyrotoxicosis, etc.).

Risk factors for developing myocarditis

The development of inflammatory heart diseases is provoked by:

• decreased immunity;
• viral infections and acute infectious diseases (ARVI, tonsillitis);
• foci of chronic infection (caries, tonsillitis);
• hereditary predisposition to inflammatory heart diseases;
• parasitic and fungal diseases.

Diagnosis of endocarditis

Qualified diagnosis of infective endocarditis is a whole complex of examinations. The patient is prescribed a cardiac screening program, which includes:

• various types of electrocardiogram (24-hour monitoring, stress echocardiography);
• Ultrasound of the heart and blood vessels;
• computer sphygmomanometry.

Modern diagnostic methods are also applicable: cardiac rhythmography, Dopplerography. Blood tests and cultures for sterility are required - one of the most important examinations for infective endocarditis.

Treatment of endocarditis

At an early stage, treatment of infective endocarditis consists of antibiotic therapy and cardiac support with medications. If septic endocarditis has already manifested itself as significant changes in the tissues of the heart (damage to the valves, aorta, myocardium), surgical intervention is possible.

• Antibacterial treatment for symptoms of endocarditis involves the use of modern antibiotics (benzylpenicillin, penicillins, amphotericin, etc.) administered intravenously.
• Passive immunization is carried out to neutralize bacteria in the body. For this purpose, special antitoxic serums (immunoglobulin, hyperimmune plasma) are most often used intravenously.
• Surgical intervention is performed in cases where it is necessary to remove foci of infection in the tissues of the heart and restore cardiac structures altered by the disease. The services of a cardiac surgeon are necessary if the patient has progressive heart failure, vascular thromboembolism, etc.

Prevention

Prevention of septic endocarditis will include timely sanitation of foci of infection, high-quality treatment of staphylococcal infections, mandatory use of antibiotics after any surgical intervention and clinical observation by specialists in the presence of chronic diseases.

Be careful about your health and remember that disease is much easier to prevent than to treat.

Related services: Cardiac Check-up Diagnosis of heart rhythm disorders by ECG monitoring