Cardiology: Endocarditis — Differential diagnosis and conservative treatment. Treatment
Endocarditis is endocardium inflammation. In most cases, its cause is bacterial infections, and less frequently organic heart diseases, injuries, or allergies. The clinical picture of the disease is very diverse, so the diagnosis requires a detailed examination of patients.
Endocarditis is suspected upon appearance of noise and other signs of damage to the heart valves (including the skin pigmentation, enlarged spleen, blood traces in the urine). Fever indicates the bacterial form of pathology.
To confirm the suspicion, the patient is prescribed a set of studies:
- Complete blood count. The patients show an increase in white blood cell count and erythrocyte sedimentation rate.
- Blood chemistry. An increase in the concentration of alpha- and gamma-globulins, circulating immune complexes, and M immunoglobulin can be observed.
- Bacterial blood cultures. The venous or arterial blood is studied. Samples are examined for availability of infectious agents. Inoculation is repeated every 3 to 12 hours for 2 days. Such multiple studies significantly reduce the chance of error. When the first 3 to 4 tests show negative results, the special media for isolation of slowly-growing microorganisms are used.
- Echocardiography and heart MRI. They allow detecting structural changes in the heart tissues.
The diagnosis is established based on the aggregate findings.
The basis of treatment is antibiotics. Specific drugs are selected based on bacterial inoculation test findings. In most instances, therapy begins with intravenous administration of penicillins. Upon intolerance to them, the patient is transferred to macrolides and aminoglycosides. Fungal endocarditis is treated with amphotericin B. The duration of drug intake is 2 to 6 weeks.
Upon staphylococcal endocarditis, the immunotherapy is conducted simultaneously. Within 3 to 5 days, the patient receives antistaphylococcal plasma via the drip. Upon sepsis development, the plasmapheresis is administered. To facilitate the general condition, the thrombolytics and cardiac glycosides can be recommended.
After completion of the treatment course, the patient is still observed for 7 to 10 days in a hospital to prevent the disease relapses.Hide
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