null 感染性心内膜炎 感染性心内膜炎Infective EndocarditisDefinition and classificationDefinition and classification心(血管)内膜(瓣膜)感染急性 (AIE):毒力强,病程短,中毒症状明显
亚急性(SIE, SBE):毒力低,病程长自体瓣膜感染:native valve endocarditis
人工瓣膜感染:prosthetic valve endocarditis (PVE)
右心瓣膜感染性心内膜炎
right heart valve endocarditis: drug abuse, AIDS, catheterizationEtiology and MechanismEtiology and Mechanism草绿色链球菌,50%
葡萄球菌,葛兰氏阴性杆菌
AIE:
葡萄球菌,可发生于无器质性心脏病患者
SIE:
链球菌,esp. 院外感染,几乎均有心脏病基础
PVE:
表
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皮葡萄球菌,术后1年内nullEndocarditisHeart structural
abnormalityEndocardial injurythrombosisAdhesion of bacteriaDisturbance
of blood flowMechanismPathologyPathologyvegetationSystematic embolism, abscessEndocarditisKidney, Liver, Joint diseasesImmune system activationThrombus and bacteriaClinical ManefestationClinical Manefestation全身表现:
发热,高热,低热,无发热
乏力,多汗,贫血,体重减轻,食欲不振
心脏:
Murmur appearance or change
Heart failure
Arrhythmia: heart block, severeClinical ManefestationClinical Manefestation血管损害:Systematic embolism
Skin: petechiae
Spleen,
kidney,
limbs,
Brain,
Messentric embolism
免疫反应表现:
Often seen in SIE
No characteristics
Osler node, TothEmbolic lesions on the feet of a patient with Staphylococcus aureus endocarditis Embolic lesions on the feet of a patient with Staphylococcus aureus endocarditis nullSkin and Nail Lesions in staphylococcal endocarditis.
Typical subungual ("splinter") hemorrhage and numerous petechiae on the skin of the abdomenLab findingsLab findingsBlood culture:
Most important diagnostic method
Vein blood X 3 times
Negative does not exclude the diagnosis
Gram stained smear from blood culture bottle showing viridans streptococci from pt with native valve endocarditis Gram stained smear from blood culture bottle showing viridans streptococci from pt with native valve endocarditis EchocardiographyEchocardiographyTTE:
TEE: more useful
Vegetation
AV or MV insufficiency
Abscese
Aorta root abscess in TEE studyAorta root abscess in TEE studyPerivalvar abscess of MV annulus, and perforationPerivalvar abscess of MV annulus, and perforationnullVegetationDiagnosisDiagnosisThe Conception of IE
Fever > 1 week in pts with structural heart diseases or heart operation
The appearance or change of cardiac murmur
Systematic embolism with no obvious cause
Heart failure with no obvious causeManagementManagementAntibiotics:
原则:
早期、足量、联合、杀菌、4-6周
根据药敏选择
经验性:
院外:链球菌:青霉素
院内:葡萄球菌:头孢唑林+丁卡
ManagementManagement2. 手术治疗
没有
办法
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之办法
应掌握好指证:see P315
该开不开也不对ManagementManagement3. 对症治疗
内科医生具备的常规知识
Heart failure
Systematic embolism
Arrhythmias:
Arterial aneurysm: depends
ManagementManagement治愈
标准
excel标准偏差excel标准偏差函数exl标准差函数国标检验抽样标准表免费下载红头文件格式标准下载
症状改善
体征:anemia, spleen, cardiac murmur
Lab:
anemia,
Urine protein
blood culture (-): 1,2,6 wRecurrence:
same bacteria
Repeat antibiotics nullPrevention
预防性应用抗生素
Prognosis
Mortality:
AIE: 20-50%
SIE: 20%
5-year survival: 90%
Case discussionCase discussionA 56-y man
Severe lumbar pain, a 7-w fever (<39°C), and a 10-kg weight loss
History: HBP with dilated LV, reduced LVEF, and MR + — + +
pE: a grade 3/6 holo-SM, and evidence of sciatica(坐骨神经痛)nullWBC: 15,400 mm3
CRP : 12.1 mg/dL
Blood cultures: negative
Lumbosacral MRI: non-specific
Treated with analgesic medication and physical therapy null12th Day: Left hemiplegia CT of the head:recent infarction in the territory of the right middle cerebral artery. What is the next step?
TEE
null35 * 5 mm: mobileVegetation on the anterior MVnullThe patient recovered and was discharged two weeks later. 3rd month follow-up visit, only slight, left-sided muscular weakness.