Endocarditis is an inflammatory disease of the inner lining of the heart (endocardium).
The heart is a hollow muscular organ that pumps blood.
Heart consists of 3 layers:
• Pericardium is the outer layer of the heart or heart shirt”, which is the heart.
• Myocardium is the middle, muscular layer, with which the heart contracts.
• Endocardium is the inner layer of the heart, which forms the inner wall of the heart and heart valves.
Infective endocarditis is an infectious disease of the inner lining of the heart (endocardium), which affects both the endocardium and heart valves.
Often endocarditis is not an independent disease, but a complication or manifestation of other diseases.
Risk factors for endocarditis – Who can get endocarditis?
• Patients with atherosclerotic lesions of the valves of the heart (coronary heart disease).
• Patients with rheumatic valvular heart disease, (after or during rheumatic fever).
• People with traumatic injuries of the heart valves.
• Patients with heart defects.
• Patients after operation in occasion of prosthetic heart valves.
• Long-term intravenous injection – drug use.
• People with reduced immunity.
• Can get sick and healthy people, after a long physical and emotional surges.
Medical classification endocarditis
– rheumatic endocarditis develops during or after suffering rheumatism (connective tissue disease caused by Streptococcus group a);
allergic endocarditis (if allergic reactions in the body);
– intoxication endocarditis (if the effects on the body of toxic substances, alcohol, drugs, vapors, gases and poisons);
– thromboangiitis – in case of being in the endocardial thrombus, which caused an inflammation of the inner lining of the heart;
– infectious endocarditis occurs when it contacts the endocardium of bacteria, viruses and fungi or bacterial endocarditis (with damage to the heart valves), pathogens that in 80% of cases is “Staphylococcus aureus”, Pseudomonas aeruginosa, pathogenic fungi;
– prosthetic endocarditis is evolving in when the infection gets into the prosthetic heart valve and is manifested through 2 weeks after the replacement heart valve.
Causes of endocarditis
For the occurrence of endocarditis should be certain conditions and cause, namely the period of selection (getting into the blood) bacteria, in the presence of the following diseases and conditions:
• Dental caries.
• Inflammatory diseases of the oral cavity (periodontitis, periodontal disease).
• Chronic tonsillitis (frequent sore throat and enlarged tonsils).
• Boils on the body.
• Surgery, tooth removal, abortion, blood transfusion, injection drug use.
Basis of endocarditis – is the formation of deposits on the valves of the heart in the form of a mixture, which consists of bacteria, blood clots and fibrous tissue. In other words on cusps of heart valves sticks (garbage), clusters which destroy the heart valve.
Microorganisms (infection) into the blood, through the blood are spread throughout the body, fall into the heart, adhere to its valves and begin to multiply, creating a whole colonies – microbial vegetation.
These colonies of microbes capable of breaking the heart valve, thereby reducing the contractility of the heart and provoke the development of heart failure.
From broken valve can break off pieces of cloth, together with germs they can spread through the blood, causing blood vessels to the brain and cause a stroke.
Symptoms and signs of endocarditis
The beginning of the disease can be both acute and gradual. Acute development of endocarditis occurs:
• A sharp increase in body temperature up to high numbers (38,5° – 40°C).
• Shortness of breath.
• Pain in the chest.
• Pain in the joints.
• Excessive sweating.
• Skin and mucous membrane eyes turns yellow (interesest sclera).
• Is characterized by the appearance on the skin of the hands and feet specific small nodules cherry color.
• Increased vascular fragility (appear small, petechial haemorrhages in the mucous membrane of the eye).
Diagnosis of endocarditis
1. The survey allows the patient to grasp a clear communication of patient complaints with the cause of the disease.
2. On examination, the patient identifies specific bundles of Osler (hands and feet), the noise over the region of the heart, enlargement of the spleen, small skin hemorrhages.
3. Urinalysis – urine is hematuria (blood).
4. Complete blood count – increased ESR, appears leukocytosis (reaction blood on inflammation), reduced hemoglobin.
5. Is a specific blood test for the presence of the pathogen.
6. Phonocardiography (FCG) – defines a heart murmur characteristic of endocarditis.
7. ECHO (echocardiography) or ultrasound of the heart allows us to see microbial layers (microbial vegetation) on the valves.
Treatment of endocarditis
1. Designate the introduction of penicillin to 6 000 000 IU per day intravenously for 1 month, if the causative organism is coccus, appoint 14 000 000 – 24 000 000 IU per day in combination with amikacin 15 mg per day. When staphylococcal endocarditis is assigned to the group of penicillins (ampicillin, amoxicillin, oxacillin).
When intolerance of penicillins is assigned to the group of macrolides (erythromycin) and aminoglycosides. A very effective group of fluoroquinolones.
If antibiotic therapy is not effective, a second determination of susceptibility to antibiotics and prescribe new drugs taking into account the sensitivity.
2. Detoxification therapy (removal of toxins from the body) – for this purpose, conduct intravenous solutions that reduce toxicity, to weaken the influence of microbes on the body.
3. Thrombolytic therapy involves the administration of medicines to thin your blood (heparin, enoxaparin, fondaparinux) and is aimed at prevention of thromboembolism.
4. Cardiac glycosides – drugs used to reduce symptoms of heart failure (strophanthin, digitoxin, Collison).
5. Hormones are not used in view of its ability to reduce immunity.
6. Vitamins are prescribed to improve immunity.
7. In the case of fungal infection of the endocardium, is active antifungal therapy amphotericin b (intravenous drip). Fungal endocarditis is poorly treated and gives a high mortality.
If diagnosed with fungal endocarditis, conduct surgical treatment is excision of the valve and replace it on prosthesis (prosthetic heart valves), amid massive anti-fungal therapy.
Treating endocarditis in clinic
The goal of surgical treatment of endocarditis is the excision of diseased heart valves and replacing them with new prosthetic heart valves.
Indications for surgery:
• Fungal endocarditis.
• Long-term presence of microorganisms in the blood, in spite of active antibiotic therapy.
• No response to treatment within 2 weeks.
• The development of heart failure. With an increase of heart failure on the background of endocarditis and the absence of surgical treatment, mortality rates have increased by 60%.
Prevention of endocarditis includes a number of recommendations aimed at preventing the development and exacerbation of viral diseases, timely treatment, and to increase the body’s defenses (immune increase). To do this:
1. To avoid fatigue, hypothermia and viral infections.
2. With the preventive purpose it is necessary to obtain antibacterial therapy during acute and exacerbation of chronic infections, accompanied by secretion into the blood “germs”.
• For sore throat.
• Bronchitis, pneumonia.
• After tooth removal.
• After an abortion.
• After surgical operations.
3. Timely treatment and elimination of foci of chronic infection (decayed teeth, periodontal disease, sinusitis, sinusitis, tonsillitis and other).
4. Treatment of diseases of the kidneys (pyelonephritis).
5. Take vitamins and a healthy lifestyle.