Endocarditis – inflammation of the inner lining of the heart (endocardium) with rheumatism, less often with infection (sepsis, fungal infections), with diffuse diseases of the connective tissue, intoxication (uremia).
Subacute (protracted) septic endocarditis (infective endocarditis) is a septic disease with the location of the main focus of infection on the heart valves. Most often, the causative agents of the disease are streptococci, staphylococci, less often – Escherichia coli, Pseudomonas aeruginosa, Proteus, etc.
Changed valves are much more often affected with acquired and congenital heart defects, valve prostheses.
Symptoms and course. Characterized by an increase in temperature, not often with chills and sweat, with pain in the joints, pallor of the skin and mucous membranes. When the valves are damaged, signs characteristic of heart defects are detected. Inflammation of the heart muscle itself is manifested by arrhythmia, conduction disorders, signs of heart failure. When vessels are involved in the process, vasculitis (inflammation of the vessel wall), thrombosis, aneurysm (vasodilation), hemorrhagic skin rashes (bruises), infarcts of the kidneys and spleen appear. Signs of diffuse glomerulonephritis are often noted, the liver and spleen are enlarged, and slight jaundice appears. Complications are possible: the formation of heart disease, valve rupture, progression of heart failure, impaired renal function, etc. In blood tests, a decrease in hemoglobin, a moderate decrease in leukocytes,
Acute septic endocarditis is a complication of general sepsis, in its manifestations it does not differ from the subacute form, it is characterized only by a faster course.
Recognition is helped by echocardiographic examination (reveals damage to the heart valves and the growth of bacterial colonies); blood cultures can detect the causative agent of endocarditis and determine its susceptibility to antibiotics.
Treatment . Antibiotics for a long time and in high doses, immunotherapy (antistaphylococcal plasma, antistaphylococcal gammaglobulin), immunomodulators (T-activin, thymalin). If necessary, short courses of glucocorticoid hormones (prednisolone), heparin, antiplatelet agents (aspirin, kuraltil, trental), ultraviolet blood irradiation, plasmapheresis, hemosorption are used if necessary. With the ineffectiveness of antibacterial therapy for endocarditis, severe heart failure that cannot be treated, a surgical method is possible – removal of the affected valve with its subsequent prosthetics.