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7/23/2019 Bolile cardiovasculare dobandite
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BOLILE CARDIOVASCULAREDOBÂNDITE
Endocarditele infecţioaseMiocarditele acte
!ericarditeleBoala "a#asa$iTl%r&rile de rit' (i de condcere
7/23/2019 Bolile cardiovasculare dobandite
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1*Endocarditele infecţioase
1*1*Definiţie+endocardita infecţioas& ,e*i*- esteafectarea infecţioas& se.tic& a endocardli/al/lar (i 'ai rar cel .arietal const0nd din
'lti.licarea %acterian& .e leini iniţialetro'%otice a%acteriene2 relt0nd leini/e3etante (i lcero4/e3etante*
1*)*!ato3enie+ condiţii necesare .entr.rodcerea e*i*+ ano'alii strctrale cardiace2tr%lenţa fl5li san3in2 %acterie'ia*
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4 se for'ea& n tro'% ne%acterian74 se ader& 3er'enii care .rodc de5tran
e5tracellar7
4 sti'larea siste'li i'n 4 se for'ea&co'.le5e at34atc distrcti/e as.ra ţestrilor/ecine ,n distr3 %acteriile-7
4 e'%olii se.tice*
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1*6*Etiolo3ie4 Stre.tococcs /iridans4 Stafilococcs ares
4 alte+ Enterococcs2 Stafilococcs e.ider'idis2E*coli2 "le%siella2 !rotes2 fn3i
1*8*Clinic+ fe%r& s.leno'e3alie artral3ii2 artrit&2 'ial3ii leini .ete(iale2 'aclo4.a.loase sflri recent a.&rte sa 'odificate 'anifest&ri nerolo3ice+9e'i.le3ii2 con/lsii
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:
1*:*!araclinic+9e'ocltra .oiti/&
/ialiarea /e3etaţiei ,ec9o- reactanţi de fa& act&
co'.l*s*sc&t2 3a'a 3lo%*cresc*
ane'ie2 lecocito&
9e'atrie 'icrosco.ic&
E";+f&r& 'odif*s.ecifice
CT+/ialiare a%ces cer*
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1*<*Dia3nostic+4%oal& strctral& de ini'&
4inter/enţii sto'atolo3ice2 ORL2
3astroenterolo3ice2 rolo3ice
4fe%ra
49e'ocltra .oiti/&
4/ialiarea /e3etaţiei
Ta%lol .oate fi act ,stafilo- sa s%act ,stre.to-
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1*=*D3*dif*+'iocardita2 .ericardita2 CMD2
se.tice'ie de alt& natr&2 9e'o.atii 'al*1*>*Co'.licaţii+4insficienţ& cardiac&
4tl%r&ri de rit'
4e'%olii cere%rale2 .l'onare 4con/lsii
4nefrit&
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>
1*?*Trata'ent1*?*1*Etiolo3ic
49e'ocltr& ne3*+a'.icilin@3enta'icin4str*/iridans+.enicilin@3enta'icin
,aler3ie la .enicilin&+/anco'icin-
4stafilo*are+o5acilin ,sa nafcilin-@3enta'icin ,to%ra'icin-
,aler3ie la .enicilin&+/anco'icin-
Trata'ent .arenteral2 doa 'a5i'&2 drata de 84<s&.t&'0ni+ ţine' cont de anti%io3ra'&*
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1*?*)*C9irr3ical+ /e3etaţii de 'ari di'ensini2
insficienţ& cardiac& neinflenţat& d.& 18 ile de
trata'ent2 a%cese2 fistle2 r.tri /al/lare2
.ersistenţa se'nelor de infecţie (i a 9e'ocltrilor
.oiti/e*
1*?*6*Trata'entl insficienţei cardiace2tl%r&rilor de rit'2 e'%oliilor*
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1
1*1*!rofila5ie+ toate carile de MCC , n afara
DSA osti' secnd'-4 inter/enţii sto'atolo3ice (i c&i res.iratorii a'o5icilin sa a'.icilin c o or& nainte (i < ore
d.& inter/enţie4 inter/enţii 3astrointestinale (i rolo3ice
a'.icilin@3enta'icin c 6 'inte nainte (i <ore d.& inter/enţie
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)*Miocarditele acte)*1*Definiţie+ 'iocarditele snt afecţini
caracteriate .rintr4n .roces infla'ator lani/ell 'iocardli care afectea& 'iocitele2interstiţil2 ele'entele /asclare.ericardl
)*)*Etiolo3ie+4/iral& ,Co5sac$ie2IV2CMV2etc-
4stre.tococic& ,.ost infecţie-
4stafilococic& ,a%ces- 4Ric$etsii
4Borellia etc*
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1)
)*6*!ato3enie+4 in/aia direct& a 'iocardli ,SIDA2 stafilo-4 acţinea direct& a to5inelor 4 'ecanis' i'n 'ediat cellar
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)*8*Clinic+4ele'entele %olii de %a&
4'odific&rile 3*cardiace+ asrire 3*I2 3alo.
4tl%r&ri de rit' (i condcere
4cardio'e3alie
4insficienţ& cardiac& ,deseori %rsc
instalat&-+.oli.nee2 dis.nee2 ciano&2
9e.ato'e3alie2 tr3escenţa F3larelor2ede'e2
oli3rie4(oc
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)*:*!araclinic+4 R3r*+cardio'e3alie2 staa .l'onar&
4 E";+ 'ico/oltaF n toate deri/aţiile2 'odific&ri ST2
T7 tl%r&ri rit' (i condcere
4 Ec9o+dilatarea ca/it&ţilor2 di'inarea
contractilit&ţii 'iocardice
4 reactanţi de fa& act&+.oiti/e
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1:
4 eni'ele 'sclare+ .ot fi crescte
4 %io.sia endo'iocardic&+ 'odific&ri 9istolo3ice,standard de ar .entr dia3nostic-4 in/esti3aţii etiolo3ice ,/irsolo3ie2 etc*-4
alte+e5.lorare radioioto.ic&
)*<*Dia3nostic+4 feno'ene de insficienţ& cardiac& stare de
(oc2care r'ea& la scrt ti'. d.& o %oal& calr& act& /iral&2 diaree2 /&rs&tri7 RAA
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1<
)*=*Dia3nostic diferenţial4 endocardita4 .ericardita4 cardio'io.atia dilatati/&4 insficienţa cardiac& (i tl%r&ri de rit' de alt&
etiolo3ie
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1=
)*>*Trata'ent)*>*1*Etiolo3ic+ anti/irale2 anti%iotice
)*>*)*!ato3enetic4 insficienţa cardiac&+ tonicardiace ,:G dindoa al&-2 IEC2 diretice2 sedati/e2 o5i3en
4 (oc+ do.a'in ,do& sc&t&-4 corectarea tl%r&rilor 9idroelectrolitice (iacido%aice4 anticoa3lante+ 9e.arin ) iH$3Hi ,< .rie-4 corticosteroii+ contro/ersat4 I;IV : '3H$3
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)*?*E/olţie2 .ro3nostic4 e/olţia ndeln3at&2 :G2 se /indec&4 rec&dere4 tl%r&ri fncţionale VS4 corelaţia c CMD4 deces n faa act&
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1?
6*!ericarditele*6*1*Definiţie+ .ericarditele snt %oli infla'atoriiacte sa cronice ale .ericardli2 de diferiteetiolo3ii (i al c&ror si'.to'e (i se'ne clinicee5.ri'& dificltatea n '.lerea diastolic& aca/it&ţilor ini'ii*
6*)*Clasificare4anato'ic&+ .ericardite scate ,fi%rinoase- .ericardite e5sdati/e ,lic9idiene-+
sero4fi%rinoase2 .rlente2 9e'ora3ice4e/olti/&+acte cronice ,si'fia .ericardic&-
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6*6*Etiolo3ie4 infecţii+/irsri2 %acterii2 ric$ettsii2 fn3i2 %*"oc9
4 tra'atis'e .osto.eratorii4 %oli 'eta%olice (i endocrine+insficienţ& renal&2
Addison2 dia%et2 9i.otiroidis'
4 %oli ,ato-i'ne+re'atis'e2 cola3enoe4 %oli /asclare+%*"a#asa$i2 ane/ris' Ao2 infarct4 %oli aler3ice+%oala serli2 'edica'ent
4 iradierea re3inii .recordiale4 t'orile .ericardli4 .ericardita idio.atic&+ cea 'ai frec/ent& for'&
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6*8*Manifest&ri clinice6*8*1*!ericardita scat&
4 drere .recordial&2 dis.nee4 frec&tra .ericardic&6*8*)*!ericardita lic9idian&
4 drere .recordial& ,iradiere '&r st3*-2dis.nee4 asrirea 3*cardiace*
4 se'ne de ta'.onad&+ ta9i.nee2 ta9icardie2ciano&2 9i.otensine art*Jcola.s2 .ls.arado5al2 tr3escenţa F3larelor29e.ato'e3alie*
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6*8*6*!ericardit& cronic& constricti/&4drere2 Fen& .recordial&
4ta9icardie2 ciano&2 F3lare tr3escente2 .ls.arado5al2 fi5itatea (oc a.e5ian2 retracţia sistolic&4 9e.ato'e3alie i'.ortant& ,ascit&2 ede'-
6*:*E5a'ene .araclinice6*:*1*E5*radiolo3ic4re/&rsat+ '%ra cardiac& '&rit&2 dia'etr
trans/ersal l&r3it2 .edicl /asclar str0't ,as.ectde Kcaraf&-2 d%l contr2 di'inarea .lsaţiilor
,sco.ic-2 c0'.rile .l'onare clare*
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4 .ericardita constricti/&+ calcific&ri .ericardice2
cord de silet& nor'al&
6*:*)*E";+ 9i.o/oltaF2 s.radeni/elare ST2 T
nor'al sa nalt6*:*6*ec9ocardio3rafie+ /ialiarea lic9id
.ericardic
6*:*8*alte+ RA2 e5a'ene /irsoli3ice (i%acteriolo3ice2 lic9id .ericardic
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6*<*D3*diferenţial4'iocardit&2 'iocardio.atii
4insficienţ& cardiac& con3esti/&4.ne'onii2 .lereii49e.ato.atii
6*=*Co'.licaţii+ ede' .l'onar e'%olie .l'onar& ta'.onada act&
6*>*E/olţie+/indecare
constitirea si'fiei .ericardice deces .rin ta'.onad&
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):
6*?*Trata'ent6*?*1*Etiolo3ic+.ericardite se.tice ,cefalos.orine
3en*III@a'ino3licoide- 84< s&.t&'0ni7 t%c
,asociere 6 t%erclostatice-
6*?*)*!ato3enetic+corticotera.ie ,t%c2 re'atis'2
.osto.erator-2 AINS ,.ericardit& idio.atic&-2.ericardocente& ,.t*drenaF-2 .ericardioto'ie
,si'fie-*
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)<
8*Boala "a#asa$i ,sindro' 'coctanat (i
3an3lionar infantil-8*1*Definiţie+B" este o /asclit& ac*'ltisiste'ic&2
de etiolo3ie necnosct&2 caracteristic&
.ersoanelor s% : ani2 care de/olt& frec/entleini ale art*coronare*4 ende'o4e.ide'ic n a.onia2 s.oradic n alte
ţ&ri8*)*Mecanis' i'n
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)=
8*6*Si'.to'e .rinci.ale+4 fe%r& ,.este : ile-4 'anifest&ri 'coase+ conFncti/it& %ilateral&2
'coasa %cal& 9i.ere'ic&2fisri2 etc*4 'anifest&ri ctanate+ erite' .oli'orf trnc9i2
ede'2 desca'aţia 'e'%relor
4 adeno.atie ac* cer/ic* nes.rat*8*8*Alte 'anif*+artral3ii2 diaree2 icter*
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8*:*La%orator+ nes.ecific
,lecocitoa2tro'%ocitoa2 VS cresct2 ANCA @-
Afectarea cardiac& .oate fi de'onstrat& ec9o*2E";2 an3io3raf ,s&.t*64: de %oal&-
8*<*D3*dif*+
4 %olile acte infecţioase er.ti/e4 reacţiile ad/erse la 'edica'ente4 AI siste'ic&
4 into5icaţie c 'ercr
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8*=*E/olţie2 co'.licaţii+4 faa act& ,1 .0n& la 11 ile-+ /ei si'.to'e7'iocardit&2 .ericardit&2 iridociclita2 'enin3ita*
4 faa s%act& ,11 .n& la )1 de ile-+.reln3irea fe%rei7 dilataţie ane/ris'al&.erif*2ane/ris'e coronariene2 insf*'itral&2tro'%oa coronar*2 infarct
4 con/alescenţ& ,)1 .n& la 6 de ile-+ reolţias*clinice2 conFncti/ita .oate .ersista*4 faa cronic&+ steno& coronarian&2 insf*card*
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6
8*>*Trata'ent+4 I;IV ,n .ri'ele 1 ile .re/ine afectarea
coronarian&- 8 '3H$3Hi : ile
4 as.irina ,n .re/ine ane/ris'l-+ > 1'3H$3Hi i/
4 alte+ di.irida'ol 6 4 < '3H$3Hi7 %P4.ass
coronarian*