感染性心内膜炎宣讲专家讲座.pptx

感染性心内膜炎Infective Endocarditis感染性心内膜炎宣讲第1页Definition and classification心（血管）内膜（瓣膜）感染急性(AIE)：毒力强，病程短，中毒症状显著亚急性（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第2页Etiology 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，几乎都有心脏病基础PVE：表皮葡萄球菌，术后1年内感染性心内膜炎宣讲第3页EndocarditisHeart structural abnormalityEndocardial injurythrombosisAdhesion of bacteriaDisturbance of blood flowMechanism感染性心内膜炎宣讲第4页vegetationSystematic embolism,abscessEndocarditisKidney,Liver,Joint diseasesImmune system activationPathologyThrombus and bacteria感染性心内膜炎宣讲第5页Clinical Manefestation全身表现：全身表现：发烧，高热，低热，无发烧发烧，高热，低热，无发烧乏力，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第6页血管损害：血管损害：Systematic embolismSkin:petechiaeSpleen,kidney,limbs,Brain,Messentric 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第7页Embolic lesions on the feet of a patient with Staphylococcus aureus endocarditis 感染性心内膜炎宣讲第8页Skin 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第9页Lab findingsBlood culture:Most important diagnostic methodVein blood X 3 times Negative does not exclude the diagnosis 感染性心内膜炎宣讲第10页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第11页EchocardiographyTTE:TEE:more usefulVegetation AV or MV insufficiencyAbscese感染性心内膜炎宣讲第12页Aorta root abscess in TEE study感染性心内膜炎宣讲第13页Perivalvar abscess of MV annulus,and perforation感染性心内膜炎宣讲第14页Vegetation感染性心内膜炎宣讲第15页DiagnosisThe Conception of IEFever 1 week in pts with structural heart diseases or heart operationThe appearance or change of cardiac murmurSystematic embolism with no obvious causeHeart failure with no obvious cause感染性心内膜炎宣讲第16页Management1.Antibiotics:标准：标准：早期、足量、联合、杀菌、早期、足量、联合、杀菌、4-6周周依据药敏选择依据药敏选择经验性：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第17页2.手术治疗手术治疗没有方法之方法没有方法之方法应掌握好指证：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第18页3.对症治疗对症治疗内科医生具备常规知识Heart failureSystematic embolismArrhythmias:Arterial aneurysm:dependsManagement感染性心内膜炎宣讲第19页治愈标准症状改进体征：anemia,spleen,cardiac murmurLab:anemia,Urine proteinblood culture(-):1,2,6 wManagementRecurrence:same bacteriaRepeat antibiotics 感染性心内膜炎宣讲第20页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第21页A 56-y man Severe lumbar pain,a 7-w fever(39C),and a 10-kg weight lossHistory: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第22页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第23页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第24页35*5 mm:mobileVegetation on the anterior MV感染性心内膜炎宣讲第25页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第26页