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Infectious endocarditis occurs after medical procedures that were accompanied by bacteremia. The patient is worried about chills, there is rapid formation of heart disease with the development of heart failure, and the appearance of hemorrhages on the skin and mucous membranes. A distinctive feature is the lack of toradol pills from anti-inflammatory therapy. Also, do not confuse IE and warty endocarditis, which is a typical morphological change in the valves in rheumatism. There are acute verrucous endocarditis and recurrent verrucous endocarditis. The first form develops on an unchanged valve.

The valve leaflets are thin, along the line of their closure, erosions with fibrin deposition occur, which resemble warts.

It is this arrangement of warts along the valve closure line that is typical. Over time, the valve becomes hardened and blood vessels develop, which valves do not normally contain. Recurrent warty endocarditis occurs on an already changed valve as a result of repeated attacks of rheumatism. In this case, the valves change significantly - they grow together along the line of closure, sclerosis of their free edge is noted, and at the same time the tendon threads are shortened. Thus, stenosis of the orifice and valve insufficiency are formed. Newly formed vessels appear. Endocarditis in adults is caused by more than 128 different microorganisms.

Streptococcus remains the leading etiological agent. It belongs to buy toradol online and normally lives in the oral cavity. It enters the bloodstream during jaw injury, dental procedures (tooth extraction), and surgical interventions in the maxillofacial area. Viridans streptococcus (Str. Bovis) lives in the gastrointestinal tract and in recent years has been of great importance in the development of endocarditis, which occurs against the background of oncological (or inflammatory) processes in the large intestine.


The second place in the structure of pathogens is occupied by staphylococci S. Aureus and S. epidermidis. These microorganisms are isolated during the development of endocarditis in drug addicts and in patients with prosthetic valves. The type of pathogen determines the lethality of this disease. Staphylococcus aureus is the most dangerous, since it is associated with take of ketorolac pills and disability.

The pathogen produces toxins that cause changes in the coagulation systemblood and there are numerous thromboembolic complications, often incompatible with life.

The mortality rate for this type of pathogen is 60-80%. Vancomycin-resistant strains of S. aureus usually cause early endocarditis (develops the first two months after cardiac surgery).

Enterococci are most often isolated from patients who have undergone manipulations on the urogenital tract. More than 10 species belong to buy ketorolac pills online, but Enterococcus faecalis and Enterococcus faecium are of primary importance in the development of this disease. The first accounts for 70-85% of cases of endocarditis. Bartonella contains 38-98% of operated valves. In patients with leukemia, a common pathogen is fungi (Candida albicans or Aspergillus), which form large vegetations on the valves. Fungal endocarditis also occurs in drug addicts, patients with reduced immunity and with an artificial heart valve. The mortality rate for fungal infections is also high - 90-100%. Recently, there have been reports of a polymicrobial etiology of the disease in drug addicts in whom microbial associations have been identified.


It is worth mentioning the gram-positive diphtheroid bacilli, which are part of the normal flora of the skin and mouth. Rickettsia, chlamydia and legionella are rare and can be identified using serological tests or cultivation in well-equipped microbiological laboratories.

K. Robert Williams, Jr., MD, FACS, FASMBS

Cardiogenic - congenital heart defects, acquired heart defects, operations on the valve apparatus, valve prostheses, hypertrophic cardiomyopathy, mitral valve prolapse, the presence of intravascular devices (pacemakers). Medical procedures - dental, surgical, urogynecological operations, installation of ketorolac venous catheters, stay on chronic hemodialysis, manipulations on the large intestine, diagnostic invasive manipulations on the heart and blood vessels. Injection drug addiction.

Predisposing risk factors.

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Reducing the body's reactivity during operations, pregnancy, diabetes, chronic diseases, difficult working conditions, HIV infection, oncology, treatment with immunosuppressants, organ transplantation. Age - older people with degenerative changes in the valves (calcific heart disease), with inadequate immunity and poor blood rheology with the formation of blood clots on the valves and endocardium are more susceptible. Focal infection, acute and chronic foci of infection. Injuries, wounds.


Prosthetic endocarditis (PE) accounts for 15-20% of all cases. The possibility of developing the disease is higher in the first six months after implantation. The cause of early endocarditis after prosthetics is infection during surgery or in the postoperative period (through central catheters). Early PE is caused by Staphylococcus epidermidis and Staphylococcus aureus. Late occurs against the background of bacteremia associated with various manipulations; streptococci and fungi (Candida and Aspergillus) are more often inoculated.

Already on the 5-6th day from the onset of the disease, according to echocardiography, gross destructive changes in the heart valves (one or more) and perforations in them are revealed.

Symptoms of infective endocarditis. At present, compared to the antibacterial era, not all patients have the characteristic polymorphic clinical picture of this disease. For example, peripheral skin symptoms may be present only in 10-15% of cases, and glomerulonephritis is less commonly diagnosed. But fever, active inflammation of the endocardium and the rapid rate of formation of the defect are present in all patients.