The review contains information about the most common pathogens of infective endocarditis (IE) in certain categories of patients. Basing on analysis of current national and foreign sources concerning IE study there are description of conditions favoring to dominance of various microorganisms in intravenous drug users, HIV-infected patients, patients on hemodialysis, with valve prostheses, diabetes mellitus and malignant neoplasm patients, elderly patients, and pregnant women.Distribution of both as typical for IE (staphylococci, streptococci, enterococci) and rare microorganisms as well polymicrobial endocarditis in mentioned above groups is considered. There is discussion about possible reasons of prevalence of methicillin-sensitive or methicillin-resistant Staphylococcus aureus species in different IE patient categories, disease development initiated by rare forms of microbial agents in immunosuppressive patients, microbial flora features depending on terms valvular infection after valve prosthetics. Despite on consideration about predominance of one or another microorganism as an etiologic agent of IE in given clinical situation, during medical help providing it should strive for precise verification of an etiologic factor for choice of effective antibacterial treatment.
The review is devoted to the practical aspects of infective endocarditis (IE) prevention, the issues of which, as before, remain the subject of lengthy discussions. Despite repeatedly updated national and international guidelines on this topic, medical practitioners are not always fully aware of antibiotic prophylaxis of IE. After a brief consideration of the etiological, pathogenetic features and risk factors of the disease, the main provisions of 2015 European Society of Cardiology guidelines on IE prevention, which were approved by the Russian Society of Cardiology, are presented. The categories of patients with the highest risk of IE, procedures associated with an increased risk of IE (dental and other invasive procedures) are described in detail. The main practical approaches to the identification of risk groups and performing invasive procedures that influence the decision to prescribe antibiotic prophylaxis are described. Particular attention is paid to the characteristics of both first-line antibiotic drugs and alternative agents for penicillin allergy or in cases of β-lactamase secreting pathogens.
The presented article contains the clinical observation of bradycardia development in 64-year-old patient with chronic kidney disease who was in ambulatory treatment at the hemodialysis department. During electrocardiogram recording an arrhythmia was detected as a junctional rhythm. The specific changes on electrocardiogram, presence of risk factors, and data of additional collection of history disease allowed purposing the development of dangerous condition — hyperkalemia. The diagnosis was confirmed after detection of the serum potassium level. This case illustrates the necessity to consider the possibility of hyperkalemia in patients with chronic kidney diseases including those who undergoing hemodialysis treatment. Relevant clinical manifestations and changes on the electrocardiogram require the urgent assessment of the serum potassium level for timely and adequate correction of the electrolyte disorder.
The presented review concerns aortic regurgitation which occupies a significant place in the structure of valvular heart disease. The detailed anatomic and physiologic description of the aortic valve is provided. The characteristics of sinotubular, ventricular-aortic junctions, and virtual aortic annulus are presented. There are data about prevalence of aortic regurgitation on the basis of results of population studies, indicating the increase in incidence of aortic regurgitation among individuals older 70–74 years. The detailed etiologic structure of this valvular pathology is described with specifying of the most common causes of both aortic disease and aortic cusps alterations. In particular, there are some aortic diseases, resulting in acute aortic regurgitation, including acute aortic dissection and paravalvular regurgitation in incompetence of the prosthetic aortic valve; in chronic one – idiopathic dilation of the aortic root, inherited connective tissue dysplasias (Ehlers–Danlos, Marfan, and Loeys–Dietz syndromes), bicuspid aortic valve, aortitis of various origin, seronegative arthropathies (reactive, psoriatic arthritis, ankylosing spondylitis) etc. Infective endocarditis and traumatic exposure are commonly responsible for development of acute regurgitation due to aortic cusps abnormalities. Chronic aortic regurgitation as a consequence valve defects occurs in rheumatic heart disease, degenerative changes, congenital anomalies, systemic connective tissue diseases (systemic lupus erythematosus, rheumatoid arthritis), non-specific aortoarteritis, etc. The special attention is paid to pathophysiologic features of acute and chronic aortic regurgitation in the review. Acute aortic regurgitation is characterized by sudden increase in end-diastolic volume and due to the noncompliant left ventricle of normal size, it undergoes abrupt exposure a significant pre-load and after-load which results in decrease of left ventricle systolic function and stroke volume despite on relative preservation of contractile function of myocardium. In contrast to acute aortic regurgitation it is remarkable in its chronic form slow, progressive influence by increased overload of the left ventricle with possibility to adapt driven by its gradual dilation and hypertrophy.
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