感染性心内膜炎宣讲培训课件

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2Definition and classification心Etiolo

2、gy and Mechanism草绿色链球菌，50%葡萄球菌，葛兰氏阴性杆菌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3Etiology and Mechanism草绿色链球菌，5EndocarditisHeart structural abnormalityEndocardial injurythrombosisAdhesion of bacteriaDisturbance of blood flowMechanism感染性心内膜炎宣讲4EndocarditisHeart structu

3、ralEnvegetationSystematic embolism, abscessEndocarditisKidney, Liver, Joint diseasesImmune system activationPathologyThrombus and bacteria感染性心内膜炎宣讲5vegetationSystematic embolism,Clinical Manefestation全身表现：发热，高热，低热，无发热乏力，多汗，贫血，体重减轻，食欲不振心脏：Murmur appearance or changeHeart failureArrhythmia: heart bloc

4、k, severe感染性心内膜炎宣讲6Clinical Manefestation全身表现：感染性血管损害：Systematic embolismSkin: petechiaeSpleen, kidney, limbs,Brain,Messentric embolism免疫反应表现：Often seen in SIENo characteristics Osler node, TothClinical Manefestation感染性心内膜炎宣讲7血管损害：Systematic embolismClinicEmbolic lesions on the feet of a patient wit

5、h Staphylococcus aureus endocarditis 感染性心内膜炎宣讲8Embolic lesions on the feet ofSkin and Nail Lesions in staphylococcal endocarditis.Typical subungual (splinter) hemorrhage and numerous petechiae on the skin of the abdomen感染性心内膜炎宣讲9Skin and Nail Lesions in staphLab findingsBlood culture:Most important

6、diagnostic methodVein blood X 3 times Negative does not exclude the diagnosis 感染性心内膜炎宣讲10Lab findingsBlood culture:感染性心Gram stained smear from blood culture bottle showing viridans streptococci from pt with native valve endocarditis 感染性心内膜炎宣讲11Gram stained smear from blood 感染性心内膜炎宣讲培训课件Aorta root ab

7、scess in TEE study感染性心内膜炎宣讲13Aorta root abscess in TEE studPerivalvar abscess of MV annulus, and perforation感染性心内膜炎宣讲14Perivalvar abscess of MV annulVegetation感染性心内膜炎宣讲15Vegetation感染性心内膜炎宣讲15DiagnosisThe Conception of IEFever 1 week in pts with structural heart diseases or heart operationThe appeara

8、nce or change of cardiac murmurSystematic embolism with no obvious causeHeart failure with no obvious cause感染性心内膜炎宣讲16DiagnosisThe Conception of IE感ManagementAntibiotics:原则：早期、足量、联合、杀菌、4-6周根据药敏选择经验性：院外：链球菌：青霉素院内：葡萄球菌：头孢唑林+丁卡感染性心内膜炎宣讲17ManagementAntibiotics:感染性心内膜炎宣2. 手术治疗没有办法之办法应掌握好指证：see P315该开不开也不

9、对Management感染性心内膜炎宣讲182. 手术治疗Management感染性心内膜炎宣讲183. 对症治疗内科医生具备的常规知识Heart failureSystematic embolismArrhythmias:Arterial aneurysm: dependsManagement感染性心内膜炎宣讲193. 对症治疗Management感染性心内膜炎宣讲19治愈标准症状改善体征：anemia, spleen, cardiac murmurLab: anemia, Urine proteinblood culture (-): 1,2,6 wManagementRecurrence

10、: same bacteriaRepeat antibiotics 感染性心内膜炎宣讲20治愈标准ManagementRecurrence: 感染性心Prevention预防性应用抗生素PrognosisMortality: AIE: 20-50%SIE: 20%5-year survival: 90%感染性心内膜炎宣讲21Prevention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 lossHistory: HBP with dilated LV, reduced LVEF,

11、 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22A 56-y man Case discussion感染性心WBC: 15,400 mm3CRP : 12.1 mg/dLBlood cultures: negativeLumbosacral MRI: non-specific Treated with analgesic medication and physical therapy 感染性心内膜炎宣讲23WBC: 15,400 mm3感染性心内膜炎宣讲2312th 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2412th Day: Left hemiplegia CT o35 * 5 mm: mobileVegetation on the anterior MV感染性心内膜炎宣讲2535 * 5 mm: