Endocarditis - an inflammation of a valval endocardium at rheumatic disease, less often at an infection, including septic and fungic, at general diseases of a connecting tissue, intoxications (uremia).

Infectious (septic) endocarditis - septic disease with localization of the basic center of an infection on valves of heart, an endocardium, less often - on an endothelium of an aorta and large vessels. The subacute infectious endocarditis is diagnosed, if disease proceeds more than 6-8 weeks.

Etiology. More often infecting agents are streptococcuses (golden, white) or staphilococcuses, less often Gram-negative bacteria (intestinal, pyocyanic rods, etc.), pneumococcuses, mushrooms, forms of bacteria, etc.

Pathogenesis. A source of a bacteriemia can be purulent otites, genyantrites, sinusitises, a chronic infection of urinary ways (cystitises, urethrites), to operation in an oral cavity (a tonsilectomy, an ex-traction of a carious teeth), etc. Circulation of microbes in a blood leads to a lesion of valves of heart at weakening a resistance of an organism. The changed valves are much more often amazed at the got and congenital heart diseases, valval prostheses. The distortion of immunologic reactions, formation of immune complexes and their adjournment in tissues causes a lesion of various organs and systems (vessels, a myocardium, kidneys, a liver, nervous system, a lien, etc.). Embolic complications as a result of an abruption of fragments of vegetation lead to development of infarcts of a lien, kidneys, a myocardium, a brain, etc.

Signs, current. The clinical symptomatology, as a rule, arises in 2 weeks. Are characteristic a fever of wrong type, it is frequent with a cold fit and then, attributes of an intoxication - joint pains, muscles, a headache, fast fatigability, an anorexia, progressing growing thin. It is necessary consider, however, that the infectious endocarditis can to proceed and without a high fever, especially at the elderly, weakened patients, at a congestive intimate, hepatic, renal failure. Repeated (everyone 3) the thermometry helps to tap the rare rises of the temperature arising during certain time (Yanovsky's "suppository"). Paleness of integuments and mucosas is quite often taped; characteristic color « coffee with milk » meets last years not often. To peripheric signs of an infectious endocarditis carry hemorrhagic enanthesises, mucosas, a transitive cord of a conjunctiva, dense morbid nodules in a hypodermic fat of fingers of brushes or on an eminence of the big finger of palms, fine erythematic rashes on palms, and soles, spherical or oval hemorrhagic rashes with the acyanotic center on an eyeground; now these attributes meet rather infrequently. At long current of disease on a background of a chronic intoxication and a hypoxia drum-type fingers and hour glasses are formed. Attributes of a lesion of the basic impellent apparatus include the widespread arthralgias. At the primary endocarditis which has developed on intact valves, systolic hum by a left edge of a breast bone owing to formation of vegetation on a floor lunar valves in the beginning can be auscultated. In the further, at formation of an aortal failure, on an aorta the diastolic hum amplifying at an inclination of the patient forward starts to be auscultated; diastolic pressure decreases. Last years at an infectious endocarditis the mitral failure is even more often observed. At a primary lesion of the mitral valve on an apex there is the systolic hum quickly accrueing on intensity and prevalence. At a becoming infected of venous system (for example, at narcomaniacs, at a becoming infected of constant venous catheters) formation of vegetation on valves of a pulmonary trunk with development of infarcts of lungs is possible.

Complications: formation of a heart disease, break of the valves, a progressing heart failure; development of a myocardial infarction as a result of an embolism in coronary arteries is possible.