وصف
Among the finest Cardiologists in the city, Dr. Rajib Lochan Bhanja (Apollo Hospitals) in Bilaspur H O, Bilaspur-chhattisgarh is known for offering excellent patient care. The doctor holds an experience of 8 years and has extensive knowledge in the respective field of medicine. The clinic is located centrally in Bilaspur H O, a prominent locality in the city.The doctor is an esteemed member of Member Of Cardiological Society Of India (CSI), Member Of The Association Of Physicians Of India (API) and this only adds to the credibility of the doctor.
ملخص
- Infective endocarditis is an inflammation or infection of the endocardial lining of the heart, usually caused by microbial pathogens. The endocardium, normally resistant to infection due to nitric oxide and prostacyclin preventing platelet aggregation, becomes vulnerable when its endothelium is breached. This breach, often due to underlying heart conditions or prosthetic materials, leads to platelet aggregates (non-microbial thrombotic emboli or NBT) forming a breeding ground for organisms during bacteremia.
- The presentation can be acute, caused by virulent organisms like Staphylococcus aureus, leading to severe symptoms and high mortality requiring urgent intervention, or sub-acute, caused by less virulent organisms like viridans streptococci, with non-specific symptoms and potential for embolization. Predisposing factors include conditions causing bacteremia (e.g., dental procedures, IV drug use, infections) and underlying heart diseases (e.g., rheumatic heart disease, congenital heart defects). Impaired host defenses (e.g., leukemia, immunosuppression) also increase risk.
- Streptococci are the most common causative organisms, followed by Staphylococcus aureus, which can affect even healthy valves. Prosthetic valve endocarditis is often caused by coagulase-negative staphylococci. The HACEK group of organisms, associated with gastrointestinal issues, are less common. In some cases, the causative organism cannot be identified, leading to culture-negative endocarditis, possibly due to prior antibiotic use or slow-growing organisms.
- Pathogenesis involves endothelial disruption, platelet aggregation, and bacterial colonization on these aggregates. This leads to infective endocarditis and potential septic emboli affecting various organs. Location of lesions typically involves the aortic and mitral valves, and pathology varies from small vegetations to larger, friable growths composed of fibrin, platelets, bacteria, and inflammatory cells.
- Diagnosis relies on blood cultures and echocardiography (transthoracic or transesophageal). Modified Duke criteria, involving major (positive blood culture, echocardiographic evidence) and minor (predisposing factors, fever, embolic phenomena) criteria, are used to confirm the diagnosis. Transesophageal echocardiography offers higher sensitivity, particularly for prosthetic valve assessment.
- Complications include congestive heart failure (a common and critical indication for surgery), uncontrolled infection, valvular destruction, and systemic embolization. Treatment strategies involve antimicrobial therapy and/or surgical intervention. Antimicrobial therapy typically lasts 2-6 weeks, while surgical indications include heart failure, uncontrolled infection, perivalvular abscess, prosthetic valve endocarditis, and major emboli.
- Mortality rates vary depending on the organism virulence, presence of complications, and patient condition. Staphylococcus aureus infections exhibit higher mortality, while streptococcal infections have lower rates. Prevention strategies include antimicrobial prophylaxis for high-risk patients undergoing procedures with potential for bacteremia, with guidelines available from organizations like the American Heart Association.
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