Infective endocarditis in adults

With infective endocarditis, not only the inner surface of the heart is affected, but also the valves. As a result, severe defects develop, which then require surgery so that the heart can work normally.

What is endocarditis

Infective endocarditis (acute or chronic) is an inflammatory process that is caused by pathogens. It is believed that this is one of the variants of a septic lesion, when pathogens enter the bloodstream and then settle on the inner lining of the heart and its valves. As a result, the organ suffers, it works worse, the valves are deformed, and heart defects occur.

Causes of infective endocarditis in adults

Most often, pathogenic pathogens enter the bloodstream to infective endocarditis. These are bacteria, viruses, less often fungi. They spread throughout the body, settle on the inner walls of the heart, damaging them and provoking the formation of blood clots.

In different forms of infective endocarditis, inflammation is provoked by different types of microorganisms:

• Esli это subacute form (lasting more than 2 months) is usually streptococcus and staphylococcus aureus. Bacteria usually come from the mouth and digestive system.
• Esli это acute endocarditis – its causes are more often gonococcus, pneumococcus and staphylococcus aureus. Often these bacteria provoke heart defects.
• Endocarditis of the right side of the heart is often caused by conditionally pathogenic flora – candidiasis, staphylococcus, can develop after catheterization and administration of drugs.
• After valve replacement, endocarditis is associated with ingress of pathogens during surgery. In this case, staphylococci, Haemophilus influenzae, and fungi are dangerous.

Risk factors for the development of bacterial endocarditis:

• heart valve surgery with implantation of artificial or biocompatible prostheses;
• the presence of congenital heart defects;
• immunodeficiency states;
• self-medication with antibiotics, especially long-term;
• stay in a hospital, on bed rest for a long period.

Symptoms of infective endocarditis in adults

The first symptoms of endocarditis may occur 1 to 2 weeks after infection, surgery, dental treatment, or invasive procedures. The disease can be both acute and gradual. In rare cases, endocarditis has minimal symptoms and occurs almost imperceptibly for the patient himself. Manifestations consist of two groups of symptoms – general, on the part of the whole body, and local – on the part of the heart.

Common features:

• fever;
• severe fluctuations in temperature with sweating and chills;
• severe weakness;
• a sharp decrease in appetite, weight loss;
• soreness of the joints and muscles, aching bones.

Heart symptoms:

• rhythm disturbances;
• pathological noises when listening with a phonendoscope;
• heart failure;
• chest pain;
• edema.

There may also be signs of thromboembolism in the branches of the pulmonary artery, kidney damage, headaches, signs of brain disorders. On the skin, there may be small hemorrhages, as from a needle prick, hematomas in the area of ​​uXNUMXbuXNUMXbthe nails, nodules on the fingers and toes, hemorrhages in the retina, swelling of the joints.

Treatment of infective endocarditis in adults in adults

Bacterial endocarditis is a very serious diagnosis, treatment cannot be delayed. Therefore, it is important to see a doctor as soon as possible, especially if there have been recent interventions or heart surgery, and then there was a deterioration.

Diagnostics

It is difficult to suspect this disease only on the basis of symptoms. A number of additional studies need to be carried out. These include:

• blood tests (identifying signs of inflammation – leukocytosis, accelerated ESR);
• blood culture for sterility with the definition of bacteria;
• blood biochemistry with changes in indicators – the level of globulins, CEC, anti-tissue antibodies, CRP;
• Ultrasound of the heart with the detection of valve lesions and growths on the inner shell, blood clots in the lumen of the heart;
• MRI of the heart or MSCT – they will show if there are signs of inflammation, damage to structures.

Modern treatments

“According to Russian and European recommendations, successful treatment of infective endocarditis is based on the destruction of pathogens with antimicrobial drugs,” says cardiologist Anna Grebennikova. – Treatment should begin immediately. Until culture results are obtained, antibiotic therapy is carried out. When a specific pathogen is isolated, its sensitivity to antibiotics is determined.

Endocarditis is treated with medications: prosthetic valve – at least 6 weeks, natural – 2 – 6 weeks. The scheme of antibiotic therapy depends on the pathogen. In this case, the patient should be under the supervision of cardiologists, cardiothoracic surgeons and infectious disease specialists.

Surgery is indicated if endocarditis is caused by Staphylococcus aureus or other antibiotic-resistant bacteria. It is also indicated if an abscess of the heart valves and paravalvular structures has begun – this is a life-threatening condition and such complications cannot be treated with antibiotics alone. The main tasks of surgical intervention are the removal of affected tissues and the restoration of the functional anatomy of the heart.

In general, indications for surgical treatment are:

• ineffective antibiotic therapy or sepsis;
• large, mobile vegetation;
• repeated episodes of embolism;
• abscess of the heart.

In case of severe damage or destruction of the valve, prosthetics are usually performed. Possible plastic valve and removal of vegetation.

Prevention of infective endocarditis in adults in adults at home

If there is an increased risk of developing infective endocarditis, regular check-ups with a doctor should be considered. It is also important to treat all foci of infection – carious teeth, urinary tract, sore throat.

When carrying out any manipulations, it is necessary to carefully monitor the state of health, take all the drugs that the doctor recommends for prevention.

It is also important to protect yourself from infections – get vaccinated against influenza, pneumococcal and hemophilic, meningococcal infections, protect against SARS.

Popular questions and answers

Infective endocarditis is a severe inflammatory disease of the endocardium (the inner lining of the heart), which often occurs with damage to the heart valves, and less often affects other structures of the heart: septa, chords, walls of the atria or ventricles, perivalvular structures. About the danger of this disease, she told us cardiologist Anna Grebennikova.