morphologic organization

• Endokarditis
• Endokarditis
• Endocarditis polyposy/ulceropolyposa
• Endocarditis fibroplastica

Abakterielle Endokarditis

• Endocarditis verrucosa rheumatica
• Endocarditis verrucosa simplex
• Endocarditis with Karzinoid

Bacterial Endokarditis

The Endokarditis in the case of innate heart errors

In the case of all heart errors, in the case of which the bloodstream is not normal in the heart "„"“, it can come by turbulences of the bloodstream in again and again the same places to smallest injuries of the heart interior skin. These places are then susceptibly to an inflammation if (usually) bacteria in the blood come and from there from an infection begin, which spreads to further portions of the heart interior skin and one or more Herzklappen.

Releasing germs

The most frequent releasing germs of a Endokarditis are bacteria (Streptokokken, staphylococci, Enterokokken), occasionally mushrooms. Whether viruses can release a Endokarditis, is scientifically not clarified and rather is considered improbable.

Infection possibilities

Wounds, injuries and feverful illnesses (e.g. Bronchitis, pneumonia, almond inflammation and Harnwegsinfekte) can be the reason for the fact that bacteria arrive in the blood and form the basis for a Endokarditis, which is prevented with heart-healthy humans by the lymphatic vessel system (liver, spleen, lymph node, Fresszellen) in time. Medical measures such as reflections of body cavities, operations at Urogenitaltrakt and intestine are connected with a high risk of a germ sowing in the blood. All dental measures (e.g. Scaling, using a tooth clip, and with which an injury of the gums is possible, a high danger for the emergence of a Endokarditis is provable (contrary to normal tooth change, there here no exciters into the fabric to be spent).

Prophylaxis

With all flatable interferences (dentist, Endoskopie, operation S. o.) with the patient with innate heart error therefore a prophylaxis is important. That means the gift of a highly effective antibiotic approx. two hours before the treatment and with patients with high Endokarditisrisiko a second gift some hours after. This time of the medication is enough from to the bacteria mirrors in the blood again pleases is.

Treatment of feverful illnesses

When all illnesses, which were caused by a bacterial infection (S. o.), a strict treatment with a highly effective antibiotic is to be prevented over sufficiently long time absolutely necessarily around the emergence of a Endokarditis additionally or as consequence of the basic illness. In addition the demarcation between viralem and bacterial Infekt is absolutely necessary by a physician. Antibiotics do not work with viralen Infekten. Therefore an antibiotic gift would be with a viralen Infekt an additional load for the body, but no assistance.

Endokarditis risk

The risk for a Endokarditis is estimated as follows today (2004)

high risk:

• artificial Herzklappen
• Implantation of artificial container connections (also transplants from human fabric)
• aorto pulmonale Shunts
• Endokarditis already gone through
• cyanotic heart errors

normal risk:

• all innate heart errors with false formations of large containers (except see below)
• "„Mitralklappenprolaps "“with leakage of the flap
• Operations using foreign material
• hypertrophe obstructive Kardiomyopathien

small risk:

• ASD II (forecourt septum defect of the Sekundumtyp)
• Cardiac pacemaker carrier
• Operations without use of foreign material (seam catch of a ASD, a VSD or a prevention of a PDA six to twelve months after the operation)
• Mitralklappenprolaps without Mitralklappeninsuffizienz (leakage of the flap)

According to this organization all patients with innate heart error of their Kardiologen get a Endokarditispass. It is important to submit this passport with all situations specified above and adhere strict to the recommendations. If a dentist should not consider the recommendations, it is very advisable to change the dentist immediately!

How does one recognize a

• Clinical indications:
  • Fever, without other disease characters
  • Heart noises (new or changed in the sound)
  • general reducingness, disease feeling
  • Spleen enlargement
  • Heart insufficiency character (water storages, liver enlargement)

• Laboratory:
  • Inflammation character
  • Anemia (blood poverty)
  • Traces of blood in the urine
  • Indication of the kidney malfunction
  • Proof of bacteria in blood cultures

• Echokardiographie:
  • possibly vegetations (= "„rampant growths and supports "“, which the body in the ignited place in the heart forms as "„repair procedure "“) are visible.

Driven a Endokarditis

• Destruction of Herzklappen
• Vegetations (S. o.) are torn off by the pumping heart and clog with their river by the cycle of blood vessels in the organs. The feared complications from it can be: a brain impact, a Nierenembolie or a pulmonary embolism.
• Kidnapping of germs into other organs, where then abscesses can form.

In the course of the blood poisoning (Sepsis) and that September tables and/or toxic shock with poison-forming bacteria it can come to an acute organ loss (kidney failure, so-called shock kidney and/or lung failure, so-called shock lung).

Diagnostics and therapy

For the diagnostics of a Endokarditis the Echokardiografie and laboratory tests are available. The proof of heart flap changes or vegetations in the heart, arisen again, or the proof of germs in the blood culture are safe indications. Both proofs are difficult however sometimes to furnish, because despite available Endokarditis still no flap changes/vegetations formed or the proof of germs in the blood culture does not succeed because the patient before already to antibiotics got. If the proof of bacteria in the blood culture does not succeed (5 to 10% of the cases), then must be treated when being present the clinical indications "„blindly "“. One accomplishes clinically under initially strict bed peace a broadly effective antibiotic therapy in the form of syringes or infusions over a time of four to six weeks. Afterwards an in to two-week critical Beobachtung.Trotzdem follows remains a once gone through Endokarditis a increased risk for a further illness. Therefore the prophylaxis (S. o.) should be taken very seriously.

See also

Aortenklappeninsuffizienz

Articles in category "Endokarditis"

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