Infectious (septic) endocarditis is a bacterial infection of heart valves or endocardium, which developed due to the presence of congenital or acquired heart disease.
The infection can develop acute or exist covertly, to have lightning-fast or take a protracted course. Infective endocarditis in the absence of treatment is always lethal ends. Infection caused by microorganisms existing in an organism with low pathogenic microorganisms, is usually sub acute in nature, whereas infection with highly pathogenic microorganisms, usually occurs acutely.
For septic endocarditis is characterized by fever, the presence of noise in the heart, splenomegaly, anemia, hematuria, manifestations of embolism. Destruction of the valve can lead to acute failure of the left atrioventricular valve and the aortic valve, requiring urgent surgical intervention.
In the past before the advent of antimicrobial drugs in 90% of bacterial endocarditis was caused by streptococcus, which is falling in the region of the heart due to infectious diseases of the upper respiratory tract, most commonly in young adults with rheumatic heart disease.
Currently ill predominantly older people, often men with congenital or acquired heart disease, infected during a hospital stay or as a result of drug use. In such cases, the agent usually is not streptococcus. In patients with prosthetic heart valves are at risk of infection from organs, implanted during surgery, or due to transient bacteremia, affecting heart valves through the months and years after surgery.
Most often the impetus for the development of septic endocarditis is a transient bacteremia. Transient bacteremia S. viridans is usually observed if, after dental procedures, tooth extraction, tonsillectomy venue manipulation irrigate with water, or in cases where the patients after these procedures begin to take food. The risk of bacteremia significantly increased in the presence of any infectious lesions of the oral cavity. Enterococcal bacteremia may be the result of manipulation of the infected urogenital tract, for example, the result of bladder catheterization or cystoscopy. ?Septic endocarditis frequently develops in patients with heart disease, but sometimes the bacteria with sufficient virulence, can affect the heart valves and in healthy people. Infectious process often captures the left side of the heart. The frequency of defeat septic endocarditis valves is located as follows: left atrioventricular valve, aortic valve, right atrioventricular valve, pulmonary trunk.
To the development of septic endocarditis predispose the presence of congenital bicuspid valve aortic valve calcification as a result of atherosclerosis in elderly patients, Mitral valve prolapse, mechanical or biological prosthetic heart valves, Marfan syndrome, the presence of arteriovenous shunts, ventricular septal defect. Bacterial endocarditis is rarely triggered by atrial septal defect.
If untreated, patients with septic endocarditis rarely recover. However, when adequate antibiotic therapy survived approximately 70% of patients with infection of the valves and own 50% of patients with prosthetic valve infection.
Factors that worsen the prognosis of the disease are the presence of congestive heart failure, elderly patients, involvement in the process of aortic valve or multiple valves of the heart, polymicrobial bacteremia. The presence of prosthetic valves, the detection of Gram-negative microorganisms, and the presence of fungal endocarditis showed a particularly poor prognosis.
Nevertheless, many patients recover with no apparent worsening of pre-existing diseases of the cardiovascular system. In that case, if antimicrobial therapy is ineffective due to resistance of the pathogen, developed recurrent endocarditis, and in the process usually involves the same valve as in the primary lesion.
Reduce mortality from septic endocarditis contribute adequate surgical treatment in combination with antibiotic therapy to suppress the infection and timely replacement of diseased valves in patients with congestive heart failure.