1、感染性心内膜炎宣讲感染性心内膜炎宣讲Definition 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,catheterization感染性心内膜炎宣讲2Etiology and Mechanism草绿色链球菌，50%葡萄球菌，葛兰氏阴性
2、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：表皮葡萄球菌，术后1年内感染性心内膜炎宣讲3EndocarditisHeart structural abnormalityEndocardial injurythrombosisAdhesion of bacteriaDisturbance of blood flowMechanism感染性心内膜炎宣讲4vegetationSystematic embolism,abscessEndocarditisKidney,Liver,Joint diseasesImmune system ac
3、tivationPathologyThrombus and bacteria感染性心内膜炎宣讲5Clinical Manefestation全身表现：全身表现：发热，高热，低热，无发热发热，高热，低热，无发热乏力，多汗，贫血，体重减轻，食欲不振乏力，多汗，贫血，体重减轻，食欲不振心脏：心脏：Murmur appearance or changeHeart failureArrhythmia:heart block,severe感染性心内膜炎宣讲6血管损害：血管损害：Systematic embolismSkin:petechiaeSpleen,kidney,limbs,Brain,Messen
4、tric embolism免疫反应表现：免疫反应表现：Often seen in SIENo characteristics Osler node,TothClinical Manefestation感染性心内膜炎宣讲7Embolic lesions on the feet of a patient with Staphylococcus aureus endocarditis 感染性心内膜炎宣讲8 Skin and Nail Lesions in staphylococcal endocarditis.Typical subungual(splinter)hemorrhage and num
5、erous petechiae on the skin of the abdomen感染性心内膜炎宣讲9Lab findings Blood culture:Most important diagnostic method Vein blood X 3 times Negative does not exclude the diagnosis 感染性心内膜炎宣讲10Gram stained smear from blood culture bottle showing viridans streptococci from pt with native valve endocarditis 感染
6、性心内膜炎宣讲11Aorta root abscess in TEE study感染性心内膜炎宣讲13Perivalvar abscess of MV annulus,and perforation感染性心内膜炎宣讲14Vegetation感染性心内膜炎宣讲15DiagnosisThe 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 n
7、o obvious cause Heart failure with no obvious cause感染性心内膜炎宣讲16Management1.Antibiotics:原则：原则：早期、足量、联合、杀菌、早期、足量、联合、杀菌、4-6周周根据药敏选择根据药敏选择经验性：经验性：院外：链球菌：青霉素院外：链球菌：青霉素 院内：葡萄球菌：头孢唑林院内：葡萄球菌：头孢唑林+丁卡丁卡感染性心内膜炎宣讲172.手术治疗手术治疗 没有办法之办法没有办法之办法 应掌握好指证：应掌握好指证：see P315 该开不开也不对该开不开也不对Management感染性心内膜炎宣讲183.对症治疗对症治疗 内科医
8、生具备的常规知识 Heart failure Systematic embolism Arrhythmias:Arterial aneurysm:dependsManagement感染性心内膜炎宣讲19治愈标准 症状改善 体征：anemia,spleen,cardiac murmur Lab:anemia,Urine protein blood culture(-):1,2,6 wManagementRecurrence:same bacteriaRepeat antibiotics 感染性心内膜炎宣讲20 Prevention 预防性应用抗生素 Prognosis Mortality:AIE
9、:20-50%SIE:20%5-year survival:90%感染性心内膜炎宣讲21A 56-y man Severe lumbar pain,a 7-w fever(39C),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）Case discussion感染性心内膜炎宣讲22 WBC:15,400 mm3 CRP:12.1 mg/dL Blood cultures:negative Lu
10、mbosacral MRI:non-specific Treated with analgesic medication and physical therapy 感染性心内膜炎宣讲23 12th Day:Left hemiplegia CT of the head:recent infarction in the territory of the right middle cerebral artery.What is the next step?TEE感染性心内膜炎宣讲2435*5 mm:mobileVegetation on the anterior MV感染性心内膜炎宣讲25 The patient recovered and was discharged two weeks later.3rd month follow-up visit,only slight,left-sided muscular weakness.感染性心内膜炎宣讲26
