endocarditis(redirected from NBTE)
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inflammation of the inner membrane, or endocardium, of the heart. Endocarditis is caused chiefly by rheumatism and sepsis. It occurs occasionally in myocardial infarction, uremia, syphilis, tuberculosis, and other diseases. The disease is usually combined with myocarditis; less commonly it occurs with pericarditis. Valvular insufficiency occurs when mostly the endocardium of the heart valves is affected.
Subacute septic, or malignant, endocarditis is caused by Streptococcus viridans or, less often, by staphylococcal or other bacteria. Change in the body’s immunity is significant. Because penetration by microbes is facilitated by injury to the endocardium and by congenital structural defects of the heart, septic endocarditis can be “superposed” on rheumatic and congenital heart disease. The necrotic and ulcerative changes that take place in the endocardium often result in arterial embolism in the systemic circulation. Inflammatory and degenerative changes and hypersensitivity vasculitis arise in the myocardium, and capillary permeability increases. The disease is manifested by fever, chills, weakness, and pain in the joints and bones. Petechial hemorrhages appear on the mucous membranes and on the skin, which acquires a greenish brown color. The terminal phalanges of the fingers thicken, causing the fingers to look like drumsticks and the nails like watch glasses. Signs of valvular disease (generally incompetence of the aortic valve) and anemia appear, and the spleen and liver become enlarged. Hemorrhagic pleurisy, focal glomerulonephritis, and other diseases may develop. The causative agent of the disease can often be isolated from the blood.
Acute septic endocarditis is less common than the subacute form. It is usually caused by hemolytic streptococcus entering the blood from the primary septic focus. The disease has similar symptoms, but its course is more severe than that of acute septic endocarditis. Endocarditis is treated mainly by prolonged administration of fairly large doses of antibiotics. Prevention requires clinical follow-up of patients with rheumatic and congenital heart diseases, elimination of focuses of infection in the body, and hardening of the body.
REFERENCETeodori, M. I. Zatiazhnoi septicheskii endokardit. Moscow, 1965.
N. R. PALEEV and S. D. KAPANADZE