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Myocardial ischemia in IE occurs quite often and is caused not only by compression of the coronary arteries, but also by coronaritis Coronaritis - inflammation of the coronary arteries of the heart, decreased blood flow as a result of aortic valve insufficiency or thromboembolic complications. It is possible to develop acute heart failure as a result of insufficiency of coronary blood flow, incompetence of the valve apparatus or fistulization of an abscess. Liver lesions in IE are characterized by the development of hepatitis, infarction or liver abscess with corresponding clinical manifestations. Possible hepatomegaly Hepatomegaly is a significant enlargement of methotrexate pills. caused by heart failure.

Specific complaints, depending on the location of the lesion, join the general ones in case of heart damage, the development of embolic or thromboembolic complications. Damage to the central nervous system can develop as a result of infectious-toxic damage (encephalitis or meningitis, immune vasculitis) or complications of IE (heart attacks, hematomas, brain abscesses). The development of infectious psychoses with psychomotor agitation, hallucinations and delusions is possible. For diagnosis, it is sufficient to identify one of the above criteria.

Changes in IE are nonspecific. If myocarditis occurs (diffuse or focal), it is possible to identify signs of AV block, smoothness or inversion of the T wave, and depression of the RS-T segment. Thromboembolism in the coronary arteries is accompanied by characteristic ECG signs of myocardial infarction (pathological Q wave, changes in the RS-T segment, etc.). The main criteria for IE of a valve prosthesis during echocardiography. microbial vegetation located on an artificial valve or paravalvular valve, heart abscess and signs of “separation” of the prosthesis. Additional criteria. paraprosthetic fistula, severe regurgitation on paraprosthetic fistulas, prosthetic valve thrombosis, effusion into the pericardial cavity, septic damage to internal organs.

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Blood culture. To detect bacteremia, it is recommended to take separate samples of venous blood in an amount of 5-10 ml at least three times with an interval of 1 hour (regardless of body temperature). If the patient has received a short course of antibiotics, cultures should be done 3 days after stopping the antibiotics. With prolonged use of antibiotics, blood culture may be negative for 6-7 days or more. After identifying the pathogen, it is necessary to determine its sensitivity to antibiotics.

• Chronic pyelonephritis in the acute stage (especially in older people) has a characteristic clinical picture (fever with chills, anemia, accelerated ESR, sometimes bacteremia), similar to buy methotrexate online involving the kidneys.
• On the other hand, patients with pyelonephritis may develop IE caused by microflora, most often found in urinary tract infections (Escherichia coli, Proteus, enterococci).
• Malignant neoplasms, especially in older people, are quite difficult to differentiate from IE.
• With tumors of the large intestine and pancreas, hypernephroma, high fever is often observed. In older people, a rough systolic murmur of mitral regurgitation, which is a consequence of chronic coronary heart disease, is often encountered.
• Also, a protodiastolic murmur of aortic regurgitation of atherosclerotic origin is often heard.

In the presence of a tumor, such patients exhibit anemia and accelerated ESR. In such situations, it is necessary to exclude a tumor before settling on the diagnosis of IE. It should be borne in mind that in elderly and senile patients a combination of IE and tumor is possible. Malignant neoplasms such as lymphomas and lymphogranulomatosis begin with hectic fever, chills, profuse sweating, and weight loss.

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The clinical picture of non-Hodgkin's lymphoma is characterized by equally frequent lymphadenopathy of both all lymph nodes and their individual groups. The first symptoms are an increase in one (50%) or two (15%) groups of lymph nodes, generalized lymphadenopathy (12%), signs of intoxication (86-94%). Blood tests reveal it. leukocyteoz (8-11%) and/or leukopenia (12-20%), lymphocytosis (18-22%), increased ESR (13.5-32%). The diagnosis is verified based on histological examination of lymph nodes.

ZS – Staphylococcus aureus (S. aureus) CONS – coagulase-negative staphylococcus (if it is sensitive to oxacillin, then gentamicin is replaced with oxacillin) 1 – this means both an immediate type reaction and a delayed type hypersensitivity 2 – or its analogues 3 – with the exception of “ intravenous" drug addicts for whom a 2-week course is sufficient 4 - intravenous administration of each dose for at least 60 minutes 5 - the total duration of treatment for patients who previously received oxacillin should be at least 4 weeks, a second course of gentamicin therapy is not carried out 6 - if sensitivity Since gentamicin has been proven in vitro, it is added for S. aureus for the full course of therapy, and for CONS - only for the first 2 weeks. If the microorganism is resistant to take methotrexate pills aminoglycosides, then fluoroquinolones are used instead of gentamicin.

Antimicrobial therapy for IE with a negative blood culture or if there are indications for urgent initiation of therapy until the type of microorganism is determined. IE with damage to native valves. Introduction The purpose of the lecture is to give an idea of the etiology, pathogenesis, clinical picture, diagnosis and treatment of infective endocarditis. Objectives of the lecture. Reveal the etiology and pathogenesis of infective endocarditis. To give an idea of the significance of the body’s reactivity and the characteristics of the pathogen in the occurrence of infective endocarditis, to describe the factors contributing to the disease.

Reveal the features of acute and prolonged septic endocarditis. Characterize the clinical manifestations of the disease. variants of the onset of the disease, temperature curve, damage to the heart and other organs (kidneys, liver and spleen, skin, etc.). Show the possibilities of laboratory diagnosis of the disease. Cover the main approaches to the treatment of infective endocarditis. choice of antibiotics, the need to use large doses, duration of therapy, indications for surgical treatment.

Definition Infective endocarditis (IE) is an infectious disease that occurs like sepsis and affects the valvular apparatus of the heart. Mostly middle-aged men (in 70% of cases) are affected. Etiology and pathogenesis The most common etiological cause (40-70% of cases) of the development of IE is viridans streptococcus. The second place is occupied by staphylococci (15% of cases). Somewhat less commonly, IE is caused by enterococci, pneumococci, Escherichia coli, Proteus, and fungi (especially Candida and Aspergillus). In total, about 70 different types of microorganisms can cause infective endocarditis.