Infectious Endocarditis complicated by embolic events, clinical case

(Coordonatori ştiinţifici: Alexandra Grejdieru, dr, conf. univ., Liviu Grib, d.h.ş.m., prof. univ.) Departamentul Medicină Internă. Disciplina Cardiologie. Clinica Medicală nr.3, USMF „Nicolae Testemiţanu”Infectious Endocarditis (IE) is a septic disease, with cardiac damage manifested by vegetations, leading to structural impairment of the heart and systemic embolism. Its incidence is 1.9 to 6.2 cases per 100,000 persons / year, mortality rate ranging from 20 to 25% [1,4,5]. Embolic complications are common signs and relevant prediction factors in patients with IE. They are revealed in 22-43% of cases with IE and cause high mortality rate and early invalidity [1,6,7]. It was found that the highest embolization rate was in IE caused by Staphylococcus aureus, Candida and HACEK group of microorganisms, in patients with large floating vegetation, located on aortic and mitral valve [2,3,6]. The authors present a clinical case of the patient P. 35, intravenous drug user with IE and embolic events involving the pulmonary artery branches, with anticardiolipin antibodies (ACA) in titer of 32 GPL. Detection of high titres of ACA in a patient with IE increases likelihood of developing embolic complications [8]. Endocardita infecţioasă (EI) este o maladie septică, ce se manifestă prin leziuni cardiace vegetante, care determină deteriorări structurale şi embolii sistemice. Incidenţa EI este de 1,9 – 6,2 cazuri la 100000 persoane/an, mortalitatea fiind de 20 – 25 % [1,4,5]. Complicaţiile embolice se dezvoltă în 22 – 43% cazuri şi constituie una din cauzele mortalităţii înalte şi invalidizării precoce [1,6,7]. S-a constatat că cea mai înaltă rată a embolizărilor este înregistrată în EI provocată de Staphylococcus aureus, Candida şi microorganismelor din grupul HACEK la pacienţii cu vegetaţii de dimensiuni mari, flotante, localizate pe valva aortică şi mitrală [2,3,6]. Autorii prezintă un caz clinic a pacientei P. de 35 ani, UDIV cu EI şi evenimente embolice în ramurile arterei pulmonare, cu anticorpi anticardiolipinici (ACL) în titru 32 GPL. Depistarea titrelor înalte de anticorpi ACL la un pacient cu EI creşte probabilitatea dezvoltării complicaţiilor embolice [8]

Metabolic syndrome and hyperuricemia

State Medical and Pharmaceutical University “Nicolae Testemitanu”, Chisinau, Republic of MoldovaIntroduction: Metabolic syndrome comprises several abnormalities that occur together: general or central adiposity, elevated blood pressure, dyslipidemia, and hyperglycemia. In addition, several other abnormalities including those of fibrinolysis, thrombosis, inflammation, and endothelial function are strongly related to the syndrome. Elevated serum uric acid levels are commonly seen in association with glucose intolerance, hypertension, and dyslipidemia. Accumulated evidence have also demonstrated that serum levels of uric acid have a significant correlation with obesity and complications of metabolic syndrome. Materials and methods: In our study were selected about 200 patients with grade land 2 hypertension aged up to 65 years. The diagnosis of metabolic syndrome was established according to the proposed criteria based on WHO recommendations (1998), NCEP / ATP III (2005) and IDF (2005). We evaluated uric acid levels and hyperuricemia in patients with MS. Results: In researched group was established a significant prevalence (57.7%) of hyperuricemia in patients with metabolic syndrome. It was noted a proportional correlation of hyperuricemia and insulin ressistance with increasing obesity degree. The same tendency was noted to the mean plasma levels of uric acid in patients with metabolic syndrome. In patients with hyperuricemia average values of the atherogenic lipid fractions (TC, TG, LDL-C) were significantly higher than in those with normouricemia and the corresponding values of HDL-C were lower, while the TC and LDL-C levels in patients with hyperuricemia exceeded the normative recommended by NCEP. It was also noted that in the group of persons with hyperuricemia, hypertrigliceridemia met 2.79 times more frequently than in individuals with normal levels of uric acid and the probability of hypertrigliceridemia in the presence of hyperuricemia was almost 3.21 times higher. Conclusion: Hyperuricemia, considered an index of metabolic disorders, was noted in 57.8% of metabolic syndrome patients and significantly correlated with the values of lipid indices (TG, LDL-cholesterol), basal glucose levels, blood pressure values and indices of obesity (body mass index and waist circumference)

Enterococcal infectious endocarditis with immunosuppressive background, case report

Disciplina Cardiologie, Clinica Medicală nr.3, Departamentul Medicină Internă, USMF „Nicolae Testemiţanu”, IMSP SCM „Sfânta Treime”Infective endocarditis (IE) is a severe microbial disease with insidious or sudden onset, which is characterised by ulcero –vegetant cardiac lesions, causing valvular damages, systemic embolism and immunological changes. IE affects primarily native and prosthetic valves, in very rare casesintact valves. IE develops in a significant number of patients with potentially immunocompromisedassociated diseases: diabetes mellitus (21%), viral hepatitis (15%), liver cirrhosis (7%), cancer (3.9%),. These diseasesbecomeadditional risk factors in IEappearance [6]. Predominant pathogenic agents in patients with IE are staphylococci (17-43%), streptococci (9-26%) and enterococci (8-13%).We present a clinical case of a 53 year old woman with primary IEof enterococcalaetiology, affecting the aortic valve with immunosuppressive background caused by breast cancer, bilateral mastectomy, eight courses of chemotherapy and two of radiotherapy. Endocardita infecțioasă (EI) este o afecțiune microbiană severă, cu debut insidios sau brusc, caracterizată de leziuni cardiace ulcero-vegetante, care determină deteriorări valvulare, embolii sistemice și modificări imunologice. EI preponderent se instalează pe valve native și protezate, mai rar pe valve intacte. Un număr important de pacienți dezvoltă EI pe fond de afecțiuni asociate: diabet zaharat (21%), hepatite virale (15%), ciroză hepatică (7%), cancer (3,9%), cu potențial imunodeprimant, care devin factori de risc suplimentar în declanșarea EI [6].Agenții patogeni predominanți la pacienții cu EI suntstafilococii (17-43%), streptococii (9-26%)și enterococii (5-20%).Prezentăm cazul clinic al unei femei de 53 de ani cu endocardită infecțioasă primară, etiologie enterococică, cu afectarea valvei aortale pe fond de imunosupresie cauzată de cancermamar, mastectomie bilaterală, 8 cure de chimioterapie și 2 de radioterapie

Bolile aortei: protocol clinic naţional PCN-242

IMSP Institutul de Cardiologie, Departamentul Cardiochirurgie ISMP SCRAcest protocol a fost elaborat de grupul de lucru al Ministerului Sănătăţii al Republicii Moldova (MS RM), constituit din colaboratorii IMSP Institutul de Cardiologie în colaborare cu IMSP Spitalul Clinic Republican. Protocolul clinic naţional este elaborat în conformitate cu ghidurile internaţionale actuale privind bolile aortice (ESC, 2014) şi poate servi drept bază pentru elaborarea protocoalelor instituţionale (extras din protocolul naţional aferent pentru instituţia dată, fără schimbarea structurii, numerotaţiei capitolelor, tabelelor, figurilor, casetelor etc.), în baza posibilităţilor reale ale fiecărei instituţii în anul curent. La recomandarea Ministerului Sănătăţii pentru monitorizarea protocoalelor instituţionale pot fi folosite formulare suplimentare, care nu sunt incluse în protocolul clinic naţional

Insidious infective endocarditis diagnosed postmortem, case report

Disciplina Cardiologie, Clinica Medicală nr.3, Departamentul Medicină Internă, USMF „Nicolae Testemiţanu”, IMSP SCM „Sfânta Treime”Infective endocarditis (IE) is a serious infectious disease which is present in a variety of forms, depending on the causative pathogen agent, pre-existing cardiac disease, presence or absence of complications, which evoluates manifest or insidious and requires an interdisciplinary approach involving specialists from different fields. Elderly patients often arise asymptomatic evolution, the onset of disease is wiped with a high rate of complications making difficult to establish its early diagnosis and postmortem findings. Untreated IE is fatal. If the diagnosis is established late or therapeutic measures are delayed, mortality rate remains at a high level, 16- 20% being for communitary and 24-50% for nosocomial IE. According to the Giovanni Di Salvo et al. 2003 study, IE has a reserved prognosis in the elderly persons with 17% in-hospital death in patients over 70 years. We present the clinical case of a 77 year woman with aortic valve endocarditis and anamnesis of degenerative aortic stenosis also presenting other comorbidities (diabetes mellitus, hypertension, viral B hepatitis), complicated by the onset of embolism syndrome (cerebrovascular accident, pulmonary and splenic mezinteric arteries embolisms). Endocardita infecțioasă (EI) este o maladie infecțioasă gravă, care se prezintă printr-o varietate de forme, în funcţie de agentul patogen cauzativ, bolile cardiace preexistente, prezenţa sau absenţa complicaţiilor, care evaluiază manifest sau insidios și necesită o abordare interdisciplinară cu implicarea specialiștilor din diferite domenii. La pacienții vârstnici maladia decurge deseori asimptomatic, debutul bolii este șters cu o rată înaltă a complicațiilor ceea ce face dificilă stabilirea precoce a diagnosticului, iar uneori constatare postmortem. EI netratată este fatală. În cazul când diagnosticul se stabilește cu întârziere sau măsurile terapeutice sunt temporizate, indicele mortalității se menține la un nivel înalt, 16-20%, pentru EI comunitare, și 24-50% pentru EI nosocomiale. Conform studiului Giovani Di Salvo et all. din 2003, EI la vârstnici are un prognostic rezervat cu deces intraspitalicesc 17% la pacienții peste 70 ani. Prezentăm cazul clinic a unei femei de 77 de ani cu endocardită infecțioasă a valvei aortale pe fond de stenoză aortică degenerativă, cu comorbidități (diabet zaharat, hipertensiune arterială, hepatită virală B), complicată cu sindrom embolic în debut (accident cerebrovascular, embolie splenică și a arterelor mezenterice)

Features of infective endocarditis with embolic complications

Introduction: Infective Endocarditis (IE) is a severe disease with in-hospital mortality up to 20%, mostly due to embolic complications that increase the risk of death about 3 times. The incidence of cerebral embolism is 17-20% of all patients with IE, while non-cerebral embolism incidence is about 23-27%, both being probably underestimated because of the silent clinical evolution. Methods: Retrospective survey of 94 adults with definite IE admitted in 3 hospitals from November 2008 through January 2012. Results: The average age of the patients was 51,8±0,6 years, including 62% men and 38% women. In our survey 16 (17%) of patients developed embolic episodes, of which cerebral embolism 6.4%, pulmonary embolism 4.3%, kidney embolism 3.2%, splenic embolism 3.2%, retinal embolism 2.1%, extremities embolism 2.1% and cardiac embolism 1.1%. There is a relatively small percentage of cerebral embolism (6,4%) compared with data reported in literature. Embolism detected in one organ had a higher rate of 81.3% (n=16) compared to embolization of two organs 18.8%. Staphylococcus aureus was more commonly detected 12,5% in patients with embolic episodes (n=16) vs. those without embolic complications - 3,8% (n=78). In patients with IE and embolic complications transthoracic echocardiography revealed vegetations in 13 (81,3%) versus 49 (62,8%) in those without embolism. In both groups aortic and mitral valve were more commonly affected, but in patients with IE and embolic conditions mobile vegetations were 1,8 times more frequently (50%) than in patients without embolism (28,2%). Also large vegetations (>20 mm) were observed by 2,5 times more frequently in patients with embolism than in those without embolic complications (12.5% vs. 5.1%). Conclusions: 1.Patients with IE complicated by embolism had more frequently proven mobile valvular vegetations and Staphylococcus aureus infection. 2. In IE, the embolic complications are widely undiagnosed and require imaging investigations (CT, MRI, Doppler investigation) for early diagnosis, initiation of appropriate treatment and prognosis improvement in these patients