Nutrition for a healthy heart

Diseases of the heart and blood vessels are the leading cause of death in the modern world. Although women suffer later than men, this disease affects both sexes. The development of the disease depends on several factors. Certain factors such as age, sex and genetic causes can not be affected, but on the other hand, however, many can not.

Diet that keeps your heart

Diseases of the heart and blood vessels are the leading cause of death in the modern world. Although women suffer later than men, this disease affects both sexes. The development of the disease depends on several factors. Certain factors such as age, sex and genetic causes can not be affected, but on the other hand, however, many can not.

Why cholesterol increases?

One of the causes of cardiovascular risk is high LDL cholesterol. A diet rich in fat, excessive food intake, physical inactivity and smoking affect the growth of cholesterol. As for diet, a high intake of saturated fatty acids and trans fatty acids most affected by the increase in LDL cholesterol in the blood. Saturated fats are most abundant in red meat, butter, full-fat dairy products and palm oil as trans fatty acids formed during the hydrogenation of vegetable oil, and heating oil in the frying of the food industry as biscuits, snacks and deep fried foods are the major source of trans fatty acids .

It is known that in addition to the "bad" LDL cholesterol that we have is 'good'. HDL cholesterol is responsible for the removal of cholesterol from the blood to the liver and its izučivanje from the body, while LDL cholesterol has an inverse role. LDL cholesterol back into the blood stream where it builds up in the walls of blood vessels. Accumulation of plaque in the walls of blood vessels from high cholesterol, triglycerides, blood pressure and many other factors, their diameter is tapered and reduced elasticity.When you break off a piece of debris resulting clot can completely clog the narrow blood vessels and thereby stop the flow of blood to the tissues. The blood flow to the heart resulting in myocardial infarction, and interrupt the flow to the brain causing a stroke.

Fruits and vegetables keeps the heart

For a healthy heart is necessary to regularly introduce foods that are rich in dietary fiber. Fiber helps to reduce cholesterol levels and improve the ratio between LDL and HDL cholesterol. In the intestine, the fibers have the ability to bind bile acids that are rich in cholesterol absorption and instead, out of the body. Fiber-rich foods such as beans, and many fruits and vegetables.

In addition to fiber, fruits and vegetables provide antioxidants in our diet, especially beta-carotene from carrots and vitamin C from broccoli, which have a protective effect on the body.

And Folic acid is an important nutrient that preserves the health of the heart. The high amount of the amino acid homocysteine ​​in the blood indicate heart disease. Although the mechanism of action has not been clarified so far, it is believed that increased amounts of homocysteine ​​promotes the accumulation of plaque in the arteries.

Valuable omega

For good health, it is advisable to enter every day at least one food that is considered a good source of beneficial omega - 3 fatty acids. This means entering a serving of sardines, tuna, salmon or other fatty fish from cold seas or of vegetable origin rich in omega - 3 fatty acids (eg, nuts, flax seeds). While the impact of the amount of hlesterola modest, omega-3 fatty acids, especially eicosapentaenoic (EPA) and docosahexaenoic (DHA) fatty acids, and have a mild antihypertensive effect and decrease the rate of formation of atherosclerotic plaques.

Heart like a Mediterranean diet

The Mediterranean diet is a diet that is now considered the most justifiable health for an individual's health, particularly in the health of the heart and blood vessels. The Mediterranean diet is rich in whole grains and fresh, seasonal vegetables and fruits. Consumed and lean meats, fish and seafood, milk and skimmed milk products and is an important part of the make and nuts and legumes. Extra virgin olive oil is an essential part of the Mediterranean diet, and it is recommended and consuming wine in moderation to 2 day DL with a recommendation to be consumed with a meal.

Studies show that a healthy life style can halve the risk of heart attack in people with a genetic predisposition to heart disease, and to reduce chances of heart attacks the strongest positive effect with a proper diet is avoiding smoking and regular exercise, maintaining a healthy body weight and moderate consumption alcohol. 

Food for heart patients

The most important in this diet is to limit the intake of fat, especially saturated (fatty meat, fatty dairy products, fried foods), which increase cholesterol and risk of heart attack or stroke. It is recommended that 25 percent of daily calories from fat, less than seven percent of daily calories from saturated fat and no more than 200 milligrams of cholesterol per day (as there are in approximately 60 grams of cheese).

Less meat, more fish

Saturated fat in the diet can be reduced by limiting the amount of meat and fatty dairy products. Choose low-fat versions of these foods. Replace most animal fats with unsaturated fats, preferably monounsaturated oils such as olive, flax or peanut oil.

TLC diet includes a lot of carbohydrates, vegetables, fruits, low-calorie and fat-free dairy products, fish, turkey and chicken (without skin).

Authors TLC diets claim that adherence to such a diet for six weeks can lower the levels of bad (LDL) cholesterol by 8 to 10 percent. Also, this diet to lose one to two pounds per week, which is actually the healthiest weight loss methods.

TABLE FOOD

- Lean red meat, chicken, turkey, fish, legumes: not more than 150 grams per day

- Eggs: no more than two yolks per week

- Fat-free milk and dairy products: two to three times a day (a cup of milk or yogurt with low-fat, 30 g of fresh skim or low-fat cottage cheese, plain cheese)

- Fruits: two to four times a day (1 piece of fruit, apple, orange, banana, or half a cup of canned fruit, or one cup of berries, melon, or 3/4 cup juice)

- Vegetables: three to five times a day (one and a half cup of raw leafy green vegetables, 1 cup of cooked or fresh vegetables; 3/4 cup low-fat vegetable soup)

- Pumpernickel bread, cereals, pasta, rice: 6 - 9 times a day (1 thin slice of bread; 1/2 rolls or whole if small; 30 g cereals 1/2 cup of cooked pasta, rice or other grains; 1/2 cups of boiled potatoes)

- Fats and oils: 6 - 8 times per day (1 teaspoon of olive oil or peanut oil, 1 teaspoon of corn, soybean or sunflower oil), two tablespoons of nuts or seeds 1 tablespoon low-fat mayonnaise

- Sweets and Cakes: Only if you have less fat and sugar

Fresh spices

They are a healthy substitute for salt, and the salt contains 2,400 milligrams of sodium in one teaspoon kavenoj. The greater the amount of sodium than you should not enter into the body during the day, if you want to keep track of your blood pressure. So - it is clear why the fresh natural flavor much better option.

Fresh chopped garlic and rosemary goes well with potatoes, parsley goes well with soup or with eggs, sage goes well with meat, thyme can be added to the popcorn. These natural herbs are also rich in antioxidants, to further protect your heart from potential heart disease. If you can not deprive the salt, it is better to use sea salt, and you can also mix (and thus mitigate) with other spices.

Are recommended and macrobiotic condiments that are very tasty and add saltiness - soy and tamari.They can be put in salads, or added to cooked dishes at the end of cooking.

Low-calorie and low-fat yogurt

Many people prefer this foodstuff is consumed at breakfast or as a snack. It contains calcium and potassium - minerals that lower blood pressure.

Garlic

These vegetables some love it, some do not, but one thing is certain - Garlic has an important role in lowering bad cholesterol. To obtain the best effect, you need to eat a few slices a day.

Olive oil

This oil is rich in unsaturated fats, which can lower cholesterol when replacing saturated fat in your diet.It is important that any reduction in the intake of saturated fats (found in cheese, the butter and fatty meats). Good substitutes are foods with olive oil (salads and dishes that are fried in the oil), avocados, nuts and other sources of unsaturated fats, especially monounsaturated fat. Olive oil has other benefits - it contains polyphenols, which prevent the bad cholesterol that sticks to artery walls. Although this is more expensive than oil sunflower, it should be part of your kitchen. The health of people do not save.

Almonds

When adults eat about 30 grams of these koštunjavih fruit per day, the level of bad cholesterol, they are reduced by 13 to 20 percent. All nuts are healthy and nutritious, but almonds are especially good for the heart because they contain a lot of vitamin E. This antioxidant has a strong effect in the prevention of atherosclerosis. They are also a good source of calcium. If you do not like raw almonds, try a little browned in the oven, it will reduce the bitterness and the flavor.


Carrot

Researchers at Harvard found that very helpful to eat every day, half a cup of carrots. This amount reduces the risk of diabetes in women by as much as 27%. 

Tetralogy of Fallot

Tetralogia Fallot's pulmonary stenosis associated with highly placed septuni ventricular defect. In this way, the right ventricular empties into the aorta instead of into the pulmonary artery and is therefore highly unsaturated aortic blood oxygen. Early leads to cyanosis, and polioitemije batičastih fingers. Fatigue causes cyanosis. 

The clinical picture

A. The signs and symptoms in severe cases lagging growth. He is a frequent dyspnea, fatigue and facilitates čučanjemse dyspnea; occasionally, until syncope. Express the signs are cyanosis ibatičasti fingers, moderate protrusion desnogventrikla and absence of apical impulse, as ikratak, harsh noise sfstolni if ​​trirduž left edge of the sternum. The heart was not enlarged. In medium-sized openings hear a loud second sound, while jepocepan with pulmonary component of reduced amplitude.


B. Radiographic findings: sučista lung fields. Apex of the heart with a dull konkavnošću in a segment.pulmonary (heart shaped wooden shoes). Right aortic arch is set U25% cases.

C. ECG: umarena desnogventrikla hypertrophy is almost always present. Povremenose are expressed and P waves.

D. Special tests: diagnosis is based on kateterijzacije heart and from the right ventricle angiokardiografije. In this way, determined and morphological appearance. Aortography is recommended as a routine method In patients who are preparing for surgery. Time to show some unexpected aortic Granell associated defects.

Treatment

Tetralogia Fallot is treated surgically with the use of the machine for extracorporeal circulation.Operative mortality was moderately low. Patients with underdeveloped pulmonary arteries previously recommended Blalockov type of surgery. Propranolol (Inderal) is used in syncopal attacks which, in fact, caused by contraction of the infundibulum.

Forecast

In adults the most common tetralogia cainotic congenital heart defects, but children do not reach adulthood so often. The most common cause of death was pronounced hypoxemia. It is also common and vascular thrombosis caused by polycythemia. Strength syndrome is depending on the degree of stenosis and. pulmonary, if the stenosis is greater the higher the desnolevi shunt and pulmonary blood flow decreased. 

Ventricular septal defect

This congenital heart defect is in fact an opening in the upper part of the interventricular septum was due to nonunion of the aortic septum. In this way, the blood passes from the left ventricle where the high right ventricular pressure where pressure is low. In cases 1/4-1/3 shunt is not large enough to lead to strain rate. In the case of a large shunt leads to stress and the right and left ventricles. 

The clinical picture

A. Symptoms and signs: clinical presentation depends on the diameter of the defect and the presence or odsustvapovećane pulmonary vascular resistance. If the defect is small levodesni shunt is small, if the defect of resistance to the flow of blood between the two ventricles is small and the large levodesnišant, increased pulmonary shunt levodesni vaskularnarezistencija decreases and turns pansistolični noise sided šum.U 3ćem 4tom and intercostals space dužsternuma heard long, loud and coarse systolic murmur and a faucet tril. This may not be the only finding small defects. In the case of large shunts at the top of the faucet heart podizanjedesnog ventricular diastolic and mean hear "flow noise" and can be heard in the third tone.
B. Radiographic findings in large šantovadesni or left ventricular or both, as the left atrium and pulmonary arteries were enlarged, and the pulmonary flow increased.


C. ECG: may be normal or may dapokazuje hypertrophy of the right, left or obaventrikla.
D. Special tests: kateterizacijomsrca possible to diagnose even unajkomplikovanijiiin cases. The children sadekompenzacijom heart is necessary to establish a diagnosis and advise appropriate treatment.

Treatment

Ventricular septum defect can be asymptomatic with normal hemodynamics of the heart. However, the children can be a serious flaw that results in death due to cardiac decompensation. These patients should undergo surgery. Ideal case in surgery with the use of the machine for extracorporeal circulation is the one with the big levodesnim Santo, left ventricular hypertrophy, and only moderate pulmonary hypertension. When it comes expressed pulmonary hypertension (pulmonary artery pressure> 85 mm Hg), and levodesni shunt is small, then the risk of surgery is at least 50%. Surgical intervention is contraindicated if the shunt Reverse. However, if a surgical intervention is necessary in such case.cardiac decompensation caused by large levodesnim SANTO recommends placing a ring around the pulmonary artery, which will reduce shunt. Only the children of 5-6 years of age it is necessary to make a definitive correction. Based on the growing experience led to the conclusion that some defects closed spontaneously (perhaps 30 - 50%). Therefore, surgery should be delayed until late childhood, except in cases where the inability to live very strong or when it is concluded that pulmonary hypertension increases.

Forecast

Patients with typical forest can expect a normal life, except that you can always develop bacterial endocarditis in patients. With large shunts in early childhood caused congestive heart and they rarely survive 40 years of age. Reverse shunt encountered in about 25% of cases, leading to Eisenmengerovog syndrome. 

Ductus arteriosus persistens

It occurs when the ductus arteriosus development embriogenetskom not close and persisted as a shunt connecting the left branch. pulmonic and aortic usually near the left. subclaviae. The blood comes from the aorta through the ductus continuous systolic and diastolic, it is a form of fistula arterijovenskc how the work of the left ventricle increases. In some patients, obliterative changes in blood vessels in the lungs leading to pulmonary hypertension. In this case, the bi-directional shunt or desnolevi. 

The clinical picture

A. The signs and symptoms: no symptoms witness performances left ventricular decompensation. The heart is in the normal range or lakouvećano with strong action at the top. A wide pulse pressure, and diastolic pressure jenizak. To the left, on the edge of the sternum in the first intercostals space idrugom hear a continuous harsh noise "machine", accented ukasnoj systole. Trillo is common. If there is a significant increase in left ventricular present iparadoksalno splitting the second tone.
B. Radiographic findings: heart normalneveličine and contour, but there may enlarge the left atrium and left ventricle. A conspicuous bulge. pulmonary, aorta and left atrium.
C. ECG: normal findings or signs of left ventricular enlargement, which depends on the width of the duct.
D. Special tests: Cardiac catheterization can establish levodesni shunt. The catheter can pass from a.pulmonic through the duct and into the aorta through angiokardiografije possible to exclude the presence of other defects (such as. ruptured sinus Valsalvae right in the heart), which produces a similar sound as the ductus arteriosus perzistens.


Treatment

In the hands of an experienced operative mortality is low (<1%), therefore it is recommended closure duetusa both in children and in adults. Operative mortality was higher in elderly patients. Therefore, we should be cautious in advising surgical intervention, particularly if the patients are asymptomatic and left ventricular hypertrophy have. The greatest risk is subacute bacterial endocarditis.
In the event that there is an indication for pulmonary kipertenzija ligation or cutting duetusa are disputed, but the contemporary view in favor ligging in all cases, while the shunt still levodesni, while pulmonary flow increases, the pressure in a. pulmonic was <100 mm Hg.

Forecast

Floe in early childhood cause high mortality. Smaller shunts are compatible with long-life age. The most common complication was congestive decrease in heart function. You can come up and bacterial endocarditis. A small percentage of patients with pulmonary hypertension and shunt and rcverzni, so the lower extremities, especially the toes cijanotični the normal color of the fingers. In this condition the patient is in surgery. 

Atrial septal defect

The most common form of atrium septum defect lectual presence ostium secundum type defects in the middle of the septum, while less common ostium primum type (which is lower in the septum) and in these cases there are abnormalities in the mitral and tricuspid valves and.In both cases, normal oxygen saturated blood from the left atrium into the right atrium passes d thus increasing cardiac output and right ventricular pulmonary flow. The primum defect, mitral insufficiency causes left ventricular strain. 

The clinical picture

A. Symptoms and signs: the largest number of patients with moderate atrial septum defect is asymptomatic. In the event that there is a large shunt and leads to dyspnea prizamoru or cardiac decompensation. Visible sui palpable right ventricular pulsations. In II IIII intercostals space to the left of the sternum to hear a moderate systolic murmur that jerezultat increased flow through the pulmonary valve. Or at the top of the heart or in the area of ​​continuing ksifoidnog hear high diastolic mekšum, which is the result of increased flow kroztrikuspidalne valve, especially in the inspiration. Trillo is not common. The second tone is widely torn and does not change in relation to respiration.


B. Radiographic findings: large pulmonary arteries with strong pulsations, increased pulmonary vascular pattern, enlarged right atrium and iventrikl small aortic knob.

C. ECG: electrical axis deviation or right ventricular hypertrophy right in the case of the ostium secundum defekta.Inkompletan or a complete block of the right granese luck in most cases. Kodostium primum defect exists devijacijaelektrične axis to the left with a rotation in the frontal plane, the opposite of the movement kazaljkena clock.

D. Special tests: cardiac catheterization ze possible to calculate the amount of blood that šantira between the left and right atria, followed Intracardiac and pulmonary pressures and pulmonary vascular resistance. The catheter can pass through the defect into the left atrium. Angiokardiografijom can odkriti whether the ostium primum comes defect or mitral regurgitation.

Treatment

Male strijalne septum defects should not be treated surgically. Surgical treatment they require lump atrium septum defects Whose is levodesni shunt (2 or 3 times the systemic flow) with mild or no increase in pulmonary resistance. Operational risk is small so you need to operate on patients whose ratio between pulmonary and systemic flow 1.5:1.

Surgical intervention is indicated in cases of pulmonary hypertension and santa reverse because of the risk of acute cardiac decompensation.

Forecast

Patients with small SANTO can live a normal life, with a greater SANTO experience medieval age or later before it comes to the appearance of pulmonary hypertension or cardiac decompensation. Later usually lead to atrial fibrillation and pulmonary vascular resistance. Floe lead to physical disability in 40tim age. Increased pulmonary vascular resistance caused by pulmonary hypertension rarely encountered in childhood or mladićstva when it comes to the atrial septum defect type secundum, but is common in the case of the septum primum defect; 40tih after years of existence and the atrium septum defect lectual secundum type can be develop pulmonary hypertension.

Operative mortality with the use of the machine for extracorporeal circulation is low (<1%) in patients under 45 years of age, who are not and have decompensated pressure in a. pulmonic <60 mm Hg.Increases 6-10% in patients over 40 years of age, they also have heart decompensation and increased pressure in a. pulmonic> 60 mm Hg. The largest number of survivors show marked improvement. 

Bacterial endocarditis

The essence of diagnosis 

Subacute:

• A patient with rheumatic or congenital heart disease.
• Long-term fever, weight loss, joint pain and muscle pain, fatigue and anemia.
• heart murmur splenomegalia, petechiae, emboli phenomena.
• Blood culture was positive.

Acute:

• Patients with acute infection, a history that iliskorim jerađena surgery.
• High temperature, sudden changes or new noises, pojavaembolija, petechiae, splenomegalia itoksične phenomenon.

General assessment

Subacute bacterial endocarditis (SBE) is a bacterial infection of the endocardium flammable, and usually builds on rheumatic or valvular or caicifikovano changed to a congenital heart disease. The initial cause of bacteremia were respiratory infections, interventions to teeth or cystoscopy. But in most cases the source of infection is not known. Etiologic factors are usually nonhemolytic Streptococcus, Streptococcus viridans and especially S. faecalis, stapholococcus occasionally, but every other organism is viable.


Bacteria settle the endocardium valve (usually aortic and mitral) or more valves. Precipitated fibrin and platelet thrombi form so that the form of vegetation that are weathered and torn easily give emboli to the brain, peripheral artery or visceral organs. Embolični nephritis or glomerulonephritis true sometimes can lead to kidney failure. Dissemination of bacteria in the blood, but altered valve can lead to the development of mikotične aneurysm, which sometimes, however, rarely, it can rupture. May be present and active rheumatic carditis. SBE develop moderate to moderate systemic symptoms: cerebral, renal, splenic or mesenteric embolism, heart failure, or any combination of these that. After this may bacterioremia from one of the sources, and in the course of a few days or weeks.

Acute bacterial endocarditis (ABE) is a progressive infection of normal speed or variable valve and usually develops in severe bacteremia from acute infections, such as eg. pneumococcna pneumonia, postabortalna pelvic infection or abscess. It can also occur as a complication after surgery on the heart, transurethral postatecoomije, or after surgery on the infected tissue. The most common pathogens are challengers: Pneumococci, hemolytic staphvlococc, betahemolitični Streptococcus and gram negative coliform organisms.

Acute endocarditis creates great weathered forms of bacteria that lead to the occurrence of severe emboličnih with metastatic abscess, perforation fast, breaking and destruction of the changed valve chordae tendineae or rupture.

The clinical picture

A. Symptoms and signs: fever is present in all cases, although there may be afebrile period. Individually or as a whole may be present following symptoms: sweating at night, chills, malaise, fatigue, anoreksia, weight loss, vague muscle aches, artralgia, redness and swelling of joints, sudden changes in the eyes, aphasia, hemiplegia caused by cerebral embolism, abdominal pain, chest pain, changes on one side of the body caused by mesenteric, spleničnim, pulmonary embolism, renal, bleeding from the nose, bruises and symptoms of heart failure. The ABE is more turbulent flow and the patient was very intoxicated.

The SBE is usually a rheumatic or congenital heart disease. Available when the tahikardia, splenomegalia, petechiae on the skin and mucous membranes, and then finding the fundus, and bleeding under the nail more available; batičasti fingers and toes, pale or tan skin, neurologic findings following cerebral embolism, sensitive red nodules on fingers and legs. Heart murmurs can be considered irrelevant when it comes to infections trikuspidalnih valves and valvular pulmonary artery. However, with repeated pulmonary infarction due to pneumonia, heart murmurs can be very characteristic signs.In elderly patients clinical presentation is often atypical.

ABE is, in fact, a serious infection associated with fever, high fever, extreme iznemoglošću serious and multiple occurrences embolism. This can be down linked to previous causal infection (pneumonia, furunculosis, pelvic infection) or may occur suddenly after surgery. Heart murmurs can change rapidly, and heart failure expires earlier.

ABE may develop during prophylactic treatment with antibiotics and inadequate. In these cases, the changes are masked, and the first warning can occur suddenly embolism, then petechiae, unexpected heart failure, altered noises or fever.

B. Laboratory findings: if the suspected SBE is necessary to take two blood cultures daily for a period of 3-5 days. For 2-7 days of incubation, 85-95% of these cultures to isolate organisms and allow the selection of a special drug. The ABE is necessary to take 2-3 blood culture during the emergency treatment of patients, and then start with antibiotic therapy. In the case of repeated negative blood cultures (in uremic patients) is necessary to make the culture of bone marrow.

The effect of drugs on antimikorbnih positive blood cultures can be expected in 10 days.

Normochromic anemia, expressed sedimentation, leukocytosis, microscopic hematuria, proteinuria, and effusions are often found in the SBE and ABE. Especially in adult patients nitrogen retention may be the first sign. In 50 - 60% of cases there is rheumatoid factor when it comes to the SBE that has lasted for more than 6 weeks.

Complications

Complications in the presence of ABE and SBE may include peripheral arterial embolism (leading to hemiplegia or aphasia; bowel infarction, kidney or spleen, or acute arterial insufficiency of the hands or feet, congestive heart failure, renal failure, krvaljenje, anemia, and create metastatic abscesses ( especially when it comes to ABE). splenic abscess may adversely affect the effect of therapy, and even lead to the initial state.

Differential Diagnosis

SBE must be differentiated from patients with a variety of similar conditions. Hemiplegia, persistent heart failure, anemia, bleeding fondness or uremia may be caused by the SBE. If a patient has of any of these diseases in addition to temperature and even a heart murmur, it is necessary to take haemoculture.

Specific illnesses that require you to differentiate are: lymphoma, thrombocytopenic purpura, leukemia, acute rheumatic fever, diseminatni lupus erythematosus, polyarthritis nodosa, chronic meningococcemia, brucellosis, diseminantna or miliary tuberculosis, non-bacterial thrombotic endocarditis or chronic disease with weight loss.

ABE cover a severe systemic reaction to the apparent pre-existing infection. It can be recognized only if notice the rapid clinical deterioration, bacteriemia, the occurrence of sudden cardiac noise changes, heart failure and high embolične attacks, especially in the CNS, which give a picture of meningitis.

Preventive measures

Some cases of endocarditis can occur after surgery on the teeth, oropharynx, and genitourinary tract.Patients with known heart anomaly must be for the above-mentioned surgery to prepare the following:
(1) 600,000 units procaine penicillinasa 600,000 units of crystalline penicillin. They are administered one hour before surgery, and then procaine penicillin 600,000 units daily to them within two days.
(2) 500,000 units of penicillin G or oral Vper 4 or 5 times a day I danhirurške intervention and two days after the execution of the intervention.
(3) In the case of sensitivity to penicillin, iliu persons who received penicillin in the prophylaxis of rheumatic fever, it is necessary to prescribe erythromycin 250 mg orally four times daily on the day of surgery and two days after the procedure.
(4) When it comes to surgery on the genitourinary or gastrointestinal tract should be given streptomycin, 1-2 gm per day, apart from the point of therapy (1).

Treatment

A. Special measures: the value of understanding regarding the treatment of bacterial endocarditis is a bactericidal antibiotic concentrations in contact with infectious organisms, which is often localized in avascular tissue, or in a place where bacteria develop. By far the most effective drug in the treatment of bacterial endocarditis is penicillin because of its high degree of bactericidal activity against most of the bacteria that cause bacterial endocarditis and because of the small number of side reactions. When necessary, the synergistic effect of antibiotics proved to be useful. Several cases have been cured only by using bacteriostatic drugs.

Positive blood cultures do not have this value to confirm the diagnosis and to be a landmark in the treatment of sensitivity tests to different antibiotics or combination of antibiotics. Before you start the treatment you need to take two blood cultures daily for a period of 3-5 days, except in cases of very severe patients where antibiotic treatment administered immediately after the emergency treatment of patients, including blood cultures 2-3.

Note: control of the antimicrobial treatment.

Blood cultures were negative minimum initial requirements for the implementation of effective therapy.Since the start of treatment serum bactericidal activity test is the best indicator to support the selection of drug and dose. During treatment the serum of patients should be bactericidal under standard laboratory conditions. Serum diluiran 1:5 or 1:10 should be rapidly bactericidal.

First Penicillin is the drug of choice in most cases of bacterial endocarditis. At first it is necessary to prescribe parenteral all patients until an adequate serum bactericidal. Per oral administration of medication can be carried out in those cases where it is a particularly sensitive organism and it is possible to implement control per oral ingestion (5 times greater than parenteral) and you can keep an adequate level of serum.

Dosage of penicillin is depending on the sensitivity of the organism. Streptococcus viridans is sensitive to 0.1 units / ml penicillin (over 8096) can be treated bacterial endocarditis administration of penicillin G, 3-5 million units per day in 3-4 weeks. Given them 1.2 million units procaine penicillin 3 times a day.Streptococci are killed using 1.0 but not using 0.1 units / ml penicillin G, which requires (dissolved in water), 5-10 million units per day in 3-4 weeks. Antibiotic can prescribe them or iv streptococci and other organisms that die of penicillin in a concentration greater than 1.0 units / ml, requiring more than 10 million units of penicillin G, which is usually administered in the form of intravenous drip infusion (5% glucose or saline solution). You need to pay attention to the following complications: (a) Each million units of "potassium penicillin" contains about 1.7 milliequivalents potassium approaching the toxic dose, (b) at high concentrations of penicillin a lot of diffusion in the CNS and thus leads to the neurotoxic state, (c) the long-term intravenous antibiotic therapy, there is the possibility of superinfection, to avoid this it is necessary to change every 48 hours post injection and all work under strict aseptic conditions.

If bakteriemia and signs of bacterial endocarditis persistent active dose may be increased (and may provide 500 million units of penicillin G per day) until the serum is not the exam, and clinical signs do not become satisfactory. However, if a negative blood culture and serum testing has shown that it is necessary to prescribe the appropriate remedy. The signs and symptoms that occur may be caused by other factors and not only by infection.

Second The combined effect of penicillin and streptomycin or kanamvicina. - Appendix kanamvcina streptomycin or penicillin bactericidal activity increases in many of streptococcus, especially for enterococe (S. faecalis). Bacterial endocarditis With caused by the streptococcus viridans streptomvcinsulfat injected them 2-3 times a day, 10 days (penicillin is added as gorerečeno). The overall time of treatment can reduce the seovako 18-22 days (instead of the 3-4nedelje). In bacterial endocarditis caused enterococima given streptomycin 0.5 gm or 0.5 gm kanamvcin intervaluod in 8-12 hours, while penicillin G (10-60miliona units daily) or ampicillin (8-20gm per day) injected iv for 4 -5nedelja. This combined therapy has been shown capable of destroying enterococa when it comes to bacterial endocarditis, when injected negopenicillin I predstavljajedan of the most useful antibiotic synergism. And a combination of other drugs that are detected through laboratory analysis can bitiod used in the treatment of bacterial endocarditis caused by resistant microorganisms in particular, but all this must be uraditipod strict laboratory control.

3rd Cephalothin given dnevnointravenski 6-12 gm, and is used for bacterial endocarditis caused by staphylococcal infection streptococnomi zapenicillin as a substitute in allergic individuals.Hypersensitivity can occur and some other phenomena nacephalothin. Enterococci are usually resistant.

4th Methicillin given dnevnoi.v 6-24 gm. for a period of 4-6 weeks. Bacterial endocarditis-use your code caused penicillinazom created staphvlococca.Alternativni drugs are Nafcillin, 8-16 gm 4puta oxacillin and 8-16 gm four times a day Uist period. Vancomvoin GM4 is given 2-4 times daily for 2-4 weeks when it comes to bacterial endocarditis caused staphvlococcom.

5th Tetracvclin, erythromycin and other drugs that are mainly a bacteriostatic effect are the drugs of choice when it pitanjubakterijski endocarditis. If ordinirajubolesnicima having fever for unknown reasons, these drugs may temporarily potisnubakteriemiju and lead to symptomatic improvement.However, they did not care able to radically destroy the infection, but the disease progresses allow smetajuu and diagnosis. In bakterijskogendocarditisa caused by the Bacteroides species and other anaerobic bacteria or rickettsia, tetracycline may be the drug of choice. The dosage must be determined on the basis of serology and patient tolerance.

6th In bacterial endocarditis who jeizazvan gram negative bacteria flora gives the interior kanamvcin, 0.5 gm imsvakih 6-12 hours. Once combined and companion drugs to give baktericidnukombinaciju by laboratory tests. Cephalothin can be given alternatively 6-12 gm four times a day. Polymyxin B icolistin have not proven clinical bacterial endocarditis korisnimkod izazvanogPseuđomonas species of organism in spite naznačeneosetljivosti you wear. Only surgical removal of the holder of infection (a "patch" over the septal defect, prosthesis) in the cardiovascular system is able to incubate bacterial endocarditis caused pseudomonasom.Gentamicin sulfate, 3 mg / kg per day odefekta them in some cases caused by the bakterijskogendocarditisa rezistentnimgram negative bacteria. In upotrebiovih drugs need to be addressed in terms of the consequences naeventualne Nephrite, neuroili oto toxicity of their actions. If Upitanju decreased renal function dose SEMORE corrected.

7th In patients with a clinical picture typical for bacterial endocarditis but stalnonegativnom hemoculture empirically given penicillin G, 20-50 million units (daily iv plus streptomycin, 1 gm / day mode for 4 weeks). In this way a treatment of disease will show znatnapoboljšanja. If there is no improvement klničkog within 3-5 days, you should try it with other drugs (see 4, 5 and 6).

8th Monitoring results and the eventual return of the disease. At the end of a lečenjaposle 3-6 weeks, stop must be svomantimikrobnom therapy. 3 days after the blood culture is taken once daily for 4 danauzastopce, and then once a week for 4 weeks, during which time patients neophodnobrižljivo observirati. During this time may result in a greater number of Bacteriological to return, but some are still extended for nekolikomeseci. And embolism and temperature can be during and after successful treatment. alisame are not sufficient basis for re-treatment. Initially well postavljenaterapija bacteriologically proven bacterial endocarditis may prove successful even up to 90%. If the bacteriological status of refunds, the organism must be isolated and retested, and then you need to take more accurate treatment with certain drugs.

Despite the treatment of a large number of patients suffering from bacterial endocarditis progression to congestive heart failure and that within 5-10 years. This mechanical heart failure is partly due to the deformation of valves (valvular perforation, torn chordae) due to bacterial infection, and partly due to the healing process and scarring. Therefore, surgical correction of impaired cardiovascular dynamics as taking part in the management of patients.

B. General assessment: it must be taken and additional treatment as in any difficult infekciji.Ako it is difficult datitransfuziju anemia need blood or red blood cells. Anticoagulant therapy (heparin, bishydroxycoumarin) are not indicated in bacterial endocarditis nekomplikovanimslučajevima and can only contribute to complications such as short krvavijenje.

C. Treatment of complications:

First Infarction sistemnoj circulation in the body usually caused by emboli from levogsrca. Emboli from right heart leading to a heart attack the lungs. Treatment is symptomatic, and anticoagulant therapy sometimes helps. Embolektomija can be taken if odreditačna localization.
Second Heart failure - myocarditis, which is often accompanied by bacterial endocarditis and valvular deformity increases, heart failure can daubrza and requires digitization and salt restriction diet. Such patients is not advisable to prescribe fiziološkirastvor potassium or calcium. even during antibiotic therapy is necessary to think about the possibility of early valve replacement akopostoje signs of progressive and severe heart failure. Because of the poor prognosis and the development of renal progresivneaortne bakterijskogendocarditisa valve replacement can be done but only after 2-3 weeks of successful antimicrobial treatment.
3rd In many patients with endocarditis odbakterijskog the retention of nitrogen due to focal emboličnog nefritisaili glomerulonephritis. This requires ponovnukorekciju dose less frequently and occasionally lečenjeuremije until renal function is not popraviza during antimicrobial therapy.

Forecast

Bacterial endocarditis is generally fatal bacterial infection while not destroyed, but in some cases surgical solution A-V fistula or perzistensa ductus arteriosus may lead to a cure. Poor prognosis in patients with negative blood culture has and prolonged treatment, then those with very high resistance of the organism and that suffered an infection of the prosthesis. If the treatment is completed bacteriological forecast depends on adequate cardiovascular function only about 50% of patients feel good 5 years after cure of bacterial endocarditis. Among the diseased aortic valves have the gravest failure prediction and requires appropriate surgical intervention. What is the worst embolism embolism prognosis that affect the brain. Cerebral embolism and aneurysm rupture mikotične can occur even after treatment undertaken. Reduction in renal function is reversible and can be achieved by early adequate antimicrobial therapy.