7 research outputs found
A case of acute infective endocarditis and septic shock
ΠΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ·Π½ΠΈΡΡ Π΅Π½Π΄ΠΎΠΊΠ°ΡΠ΄ΠΈΡ (ΠΠ) Π±Π΅Π»Π΅ΠΆΠΈ Π½Π°ΡΠ°ΡΡΠ²Π°ΡΠ° Π·Π°Π±ΠΎΠ»ΡΠ΅ΠΌΠΎΡΡ ΠΈ Π½Π΅ΠΏΡΠΎΠΌΠ΅Π½ΡΡΠ° ΡΠ΅ ΡΠΌΡΡΡΠ½ΠΎΡΡ Π²ΡΠΏΡΠ΅ΠΊΠΈ Π½Π°ΠΏΡΠ΅Π΄ΡΠΊΠ° Π² Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ°ΡΠ° ΠΈ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ΡΠΎ ΠΌΡ. ΠΡΠΈ ΠΎΠΊΠΎΠ»ΠΎ 20% ΠΎΡ ΡΠ»ΡΡΠ°ΠΈΡΠ΅ ΠΠ ΠΏΡΠΎΡΠΈΡΠ° ΠΎΡΡΡΠΎ, Ρ ΠΏΡΠΈΠ·Π½Π°ΡΠΈ Π½Π° ΡΠ΅ΠΏΡΠΈΡ ΠΈ ΡΠ΅ΠΏΡΠΈΡΠ΅Π½ ΡΠΎΠΊ, ΠΊΠΎΠΉΡΠΎ Π²Π»ΠΎΡΠ°Π²Π° Π΄ΡΠ°ΠΌΠ°ΡΠΈΡΠ½ΠΎ ΠΏΡΠΎΠ³Π½ΠΎΠ·Π°ΡΠ° ΠΈ Π΅ Π½Π΅Π·Π°Π²ΠΈΡΠΈΠΌ ΠΏΡΠ΅Π΄ΠΈΠΊΡΠΎΡ Π·Π° Π²ΡΡΡΠ΅Π±ΠΎΠ»Π½ΠΈΡΠ½Π° ΡΠΌΡΡΡ. ΠΠ°Π²ΡΠ΅ΠΌΠ΅Π½Π½ΠΎΡΠΎ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠΈΡΠ°Π½Π΅ ΠΈ ΡΠΏΠ΅ΡΠ½Π°ΡΠ° Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ½Π° ΠΈΠ½ΡΠ΅ΡΠ²Π΅Π½ΡΠΈΡ ΠΌΠΎΠ³Π°Ρ Π΄Π° ΠΏΠΎΠ΄ΠΎΠ±ΡΡΡ ΠΏΡΠ΅ΠΆΠΈΠ²ΡΠ΅ΠΌΠΎΡΡΡΠ° ΠΏΡΠΈ ΡΠ΅Π·ΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ. ΠΡΠ΅Π΄ΡΡΠ°Π²ΡΠΌΠ΅ ΡΠ»ΡΡΠ°ΠΉ Π½Π° 47-Π³ΠΎΠ΄ΠΈΡΠ΅Π½ ΠΌΡΠΆ, Π±Π΅Π· Π°Π½Π°ΠΌΠ½Π΅Π·Π° Π·Π° ΠΌΠΈΠ½Π°Π»ΠΈ ΠΈΠ»ΠΈ ΡΡΠΏΡΡΡΡΠ²Π°ΡΠΈ Π·Π°Π±ΠΎΠ»ΡΠ²Π°Π½ΠΈΡ, ΠΏΠΎΡΡΡΠΏΠΈΠ» ΠΏΠΎ ΡΠΏΠ΅ΡΠ½ΠΎΡΡ Π² ΠΠ½ΡΠ΅Π½Π·ΠΈΠ²Π½ΠΎ ΠΊΠ°ΡΠ΄ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ½ΠΎ ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΠ΅, ΠΏΠΎ Π²ΡΠ΅ΠΌΠ΅ Π½Π° COVID-19 ΠΏΠ°Π½Π΄Π΅ΠΌΠΈΡΡΠ°, Ρ ΠΈΠ·ΡΠ°Π·Π΅Π½ ΡΠ΅Π±ΡΠΈΠ»Π½ΠΎ-ΠΈΠ½ΡΠΎΠΊΡΠΈΠΊΠ°ΡΠΈΠΎΠ½Π΅Π½ ΡΠΈΠ½Π΄ΡΠΎΠΌ, Π·Π°Π΄ΡΡ
, ΠΏΡΠ΅ΠΊΠΎΡΠ΄ΠΈΠ°Π»Π΅Π½ Π΄ΠΈΡΠΊΠΎΠΌΡΠΎΡΡ ΠΈ Π±ΠΎΠ»ΠΊΠ°, ΠΊΠ°ΡΠ»ΠΈΡΠ°, Ρ
Π΅ΠΌΠΎΠΏΡΠΎΠ΅. ΠΡ Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΠΈΡΠ΅ ΠΈΠ·ΡΠ»Π΅Π΄Π²Π°Π½ΠΈΡ ΠΈΠΌΠ° Π΄Π°Π½Π½ΠΈ Π·Π° ΠΈΠ·ΡΠ°Π·Π΅Π½Π° Π²ΡΠ·ΠΏΠ°Π»ΠΈΡΠ΅Π»Π½Π° ΠΊΠΎΠ½ΡΡΠ΅Π»Π°ΡΠΈΡ, ΡΡΡΠΎ ΡΠ°ΠΊΠ° ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈ ΡΡΠΎΠΏΠΎΠ½ΠΈΠ½ I ΠΈ D-Π΄ΠΈΠΌΠ΅ΡΠΈ. Π’ΠΎΠ·ΠΈ ΡΠ»ΡΡΠ°ΠΉ ΠΏΠΎΠΊΠ°Π·Π²Π° ΡΡΡΠ΄Π½ΠΎΡΡΠΈΡΠ΅ Π² Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ°ΡΠ° Π½Π° ΠΎΡΡΡΠΈΡ ΠΠ, ΡΠΏΠ΅ΡΠΈΡΠΈΠΊΠΈΡΠ΅ Π² ΠΊΠ»ΠΈΠ½ΠΈΡΠ½ΠΈΡ Ρ
ΠΎΠ΄ Π½Π° Π±ΠΎΠ»Π΅ΡΡΡΠ°, ΠΊΠ°ΠΊΡΠΎ ΠΈ Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ΡΠΎ Π½Π° ΡΠΏΠ΅ΡΠ½Π°ΡΠ° Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ½Π° ΠΈΠ½ΡΠ΅ΡΠ²Π΅Π½ΡΠΈΡ Π·Π° ΠΏΠΎΠ΄ΠΎΠ±ΡΡΠ²Π°Π½Π΅ Π½Π° ΠΏΡΠ΅ΠΆΠΈΠ²ΡΠ΅ΠΌΠΎΡΡΡΠ°. Infective endocarditis (IE) marks an increasing morbidity and unchanged mortality despite advances in its diagnosis and treatment. In about 20% of IE cases are acute, with signs of sepsis and septic shock. Septic shock dramatically worsens prognosis and is an independent predictor of in β hospital death. Timely diagnosis and urgent surgical intervention can improve survival in these patients. We present a case of a 47-year-old man, with no history of past or concomitant diseases, who was admitted as an emergency to the Cardiology Intensive Care Unit, during the COVID-19 pandemic, with pronounced febrile-intoxication syndrome, shortness of breath, precordial discomfort and pain, cough, haemoptysis. From laboratory studies with a pronounced infl ammatory constellation, troponin I and D-dimers are also increased. This case shows the diffi culties in the diagnosis of acute IE, the specifi cs in the clinical course of the disease, as well as the importance of urgent surgical intervention to improve survival
Hypertension in pregnancy as an early sex-specific risk factor for cardiovascular diseases: evidence and awareness
Despite being a physiological condition, human pregnancy is known to cause numerous complications that can endanger the life of the mother and the fetus alike. While the majority of complications are mostly limited within the peripartum period, more and more information is available about persistently higher short- and long-term cardiovascular risk after a pregnancy complicated by a hypertensive disorder. There is evidence that women after gestational hypertension or preeclampsia are more likely to develop arterial hypertension, coronary atherosclerosis, myocardial infarction, stroke, peripheral artery disease, and even diabetes mellitus and venous thromboembolism years after the target pregnancy. This has urged some authors to view hypertensive disorders of pregnancy as a βstress testβ for the maternal organism that unmasks latent endothelial dysfunction. An explanation is sought in the presence of common risk factors and underlying pathological pathways with cardiovascular diseases, although a certain etiological mechanism for the development of hypertensive disorders in pregnancy has not been established yet. More attention is needed towards the follow-up of women after a hypertensive pregnancy as it could be an opportunity for early prevention of cardiovascular diseases
High-sensitivity CRP levels in women with gestational hypertension, preeclampsia and in normotensive pregnant women and its correlations
Introduction: Gestational hypertension is a less investigated hypertensive disorder of pregnancy than preeclampsia, but evidence exists of an unfavourable cardiovascular profile for women after such a pregnancy.Aim: To determine serum high-sensitivity C-reactive protein (hs-CRP) levels in women with preeclampsia, gestational hypertension, and in normotensive pregnancy in order to assess the cardiovascular implications and to examine its correlations with some characteristics of women.Materials and methods: Thirty-six women with gestational hypertension, thirty-seven with preeclampsia, and fifty maternal and gestational age-matched controls were included in a single-center prospective clinical-epidemiological study. Serum hs-CRP levels were determined using ELISA method.Results: Significantly higher hs-CRP levels were found in the gestational hypertension group than in the controls (p=0.043), but not in the preeclampsia group (p=0.445). The levels between the two pathological groups did not differ significantly (p=0.247). Odds ratio for hs-CRP levels higher than the provided cut-off was 3.31 (95% CI 1.32β8.29) for the presence of gestational hypertension. In the normotensive pregnant women, the hs-CRP levels had a positive correlation with BSA, pre-pregnancy and current BMI, but such correlations were absent in the hypertensive groups. There were no correlations with the maternal or gestational age, current weight gain in any of the groups or with the highest detected blood pressure in the pathological groups. These levels did not differ according to gravidity, smoking status and smoking during pregnancy.Conclusions: Elevation of hs-CRP was more pronounced in women with gestational hypertension than in women with preeclampsia, which could indicate a different pathophysiological mechanism and a higher cardiovascular risk for those women
Characteristics of infective endocarditis according to the mode of acquisition β a single-center, retrospective analysis
Π‘ΠΏΠΎΡΠ΅Π΄ Π½Π°ΡΠΈΠ½Π° Π½Π° ΠΏΡΠΈΠ΄ΠΎΠ±ΠΈΠ²Π°Π½Π΅ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ·Π½ΠΈΡΡ Π΅Π½Π΄ΠΎΠΊΠ°ΡΠ΄ΠΈΡ (ΠΠ) ΡΠ΅ ΠΊΠ»Π°ΡΠΈΡΠΈΡΠΈΡΠ° ΠΊΠ°ΡΠΎ ΠΎΠ±ΡΠ΅ΡΡΠ²Π΅Π½ΠΎ ΠΏΡΠΈΠ΄ΠΎΠ±ΠΈΡ β CAIE (Community acquired IE), ΡΠ²ΡΡΠ·Π°Π½ ΡΡΡ Π·Π΄ΡΠ°Π²Π½ΠΈ Π³ΡΠΈΠΆΠΈ β HAIE (Health careβassociated infective endocarditis) ΠΈ ΠΠ, ΡΠ΅Π·ΡΠ»ΡΠ°Ρ Π½Π° ΠΈΠ½ΡΡΠ°Π²Π΅Π½ΠΎΠ·Π½Π° Π½Π°ΡΠΊΠΎΠΌΠ°Π½ΠΈΡ β IDUIE (intravenous drug useβrelated IE). ΠΠ° ΡΠΎΠ·ΠΈ Π΅ΡΠ°ΠΏ Π»ΠΈΠΏΡΠ²Π°Ρ Π΄Π°Π½Π½ΠΈ Π·Π° ΠΡΠ»Π³Π°ΡΠΈΡ Π·Π° ΡΠ΅Π·ΠΈ ΡΡΠΈ Π³ΡΡΠΏΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ. Π¦Π΅Π»: ΠΠΎΡΡΠ°Π²ΠΈΡ
ΠΌΠ΅ ΡΠΈ Π·Π° ΡΠ΅Π» Π΄Π° ΠΈΠ·ΡΠ»Π΅Π΄Π²Π°ΠΌΠ΅ ΠΠ ΡΠΏΠΎΡΠ΅Π΄ Π½Π°ΡΠΈΠ½Π° Π½Π° ΠΏΡΠΈΠ΄ΠΎΠ±ΠΈΠ²Π°Π½Π΅ ΠΈ Π΄Π° Π½Π°ΠΏΡΠ°Π²ΠΈΠΌ ΠΊΠ»ΠΈΠ½ΠΈΠΊΠΎ-ΠΈΠ½ΡΡΡΡΠΌΠ΅Π½ΡΠ°Π»Π½Π° Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΡΡΠΈΠΊΠ° Π½Π° Π³ΡΡΠΏΠΈΡΠ΅. ΠΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄ΠΈ: ΠΡΠΎΡΡΠ²Π°Π½Π΅ΡΠΎ Π΅ Π΅Π΄Π½ΠΎΡΠ΅Π½ΡΡΠΎΠ²ΠΎ, ΡΠ΅ΡΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎ ΠΈ Π²ΠΊΠ»ΡΡΠ²Π° 270 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ, Π»Π΅ΠΊΡΠ²Π°Π½ΠΈ Π² Π£ΠΠΠΠ βΠ‘Π². ΠΠ΅ΠΎΡΠ³ΠΈβ β ΠΠ»ΠΎΠ²Π΄ΠΈΠ², Π·Π° ΠΏΠ΅ΡΠΈΠΎΠ΄Π° 01.2005-12.2021 Π³. Π Π΅Π·ΡΠ»ΡΠ°ΡΠΈ: ΠΠ°ΡΠΈΠ΅Π½ΡΠΈ ΡΡΡ CAIE ΡΠ° 64.8% (175), Ρ HAIE 26,7% (72) ΠΈ Ρ IDUIE 8,5% (23). ΠΠ°ΡΠΈΠ΅Π½ΡΠΈΡΠ΅ Ρ IDUIE ΡΠ° ΠΏΠΎ-ΠΌΠ»Π°Π΄ΠΈ ΡΠΏΡΡΠΌΠΎ ΠΎΡΡΠ°Π½Π°Π»ΠΈΡΠ΅ Π΄Π²Π΅ Π³ΡΡΠΏΠΈ β 33 (8) Π³. (Ρ = 0.000), Ρ Π½ΠΈΡΠΊΠ° ΠΊΠΎΠΌΠΎΡΠ±ΠΈΠ΄Π½ΠΎΡΡ (CCI β 1, IQR 1; p = 0.000), Ρ Π½Π°ΠΉ-ΡΠ΅ΡΡΠΎ Π΄Π΅ΡΠ½ΠΎΡΡΡΠ°Π½Π½ΠΎ Π·Π°ΡΡΠ³Π°Π½Π΅ (p < 0.001), Ρ ΡΠ΅ΡΡΠΎ ΡΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠ΅ ΡΠ΅ΠΏΡΠΈΡΠ΅Π½ ΡΠΎΠΊ β 21.7% (Ρ = 0.017) ΠΈ Ρ Π½Π°ΠΉ-ΡΠ΅ΡΡ ΠΏΡΠΈΡΠΈΠ½ΠΈΡΠ΅Π» Staphylococcus aureus (Ρ < 0.01). ΠΠ°ΡΠΈΠ΅Π½ΡΠΈΡΠ΅ Ρ HAIE ΡΠ° Π½Π°ΠΉ-Π²ΡΠ·ΡΠ°ΡΡΠ½ΠΈ (69; 18 Π³.), Ρ Π½Π°ΠΉ-Π³ΠΎΠ»ΡΠΌΠ° ΠΊΠΎΠΌΠΎΡΠ±ΠΈΠ΄Π½ΠΎΡΡ (CCI 4, IQR 3), Π±Π΅Π· ΡΠΈΠ³Π½ΠΈΡΠΈΠΊΠ°Π½ΡΠ½Π° ΡΠ°Π·Π»ΠΈΠΊΠ° ΡΡΡ CAIE (66; 20 Π³. ΠΈ CCI 3 IQR 3). ΠΠΎΠ»Π΅ΠΌΠΈΡΡ Π΄ΡΠ» Π²Ρ
ΠΎΠ΄Π½Π° Π²ΡΠ°ΡΠ° ΠΏΡΠΈ ΡΡΡ
ΡΠ° ΠΌΠ°Π½ΠΈΠΏΡΠ»Π°ΡΠΈΠΈ/ΠΏΡΠΎΡΠ΅Π΄ΡΡΠΈ (62.5%) ΠΈ Ρ
Π΅ΠΌΠΎΠ΄ΠΈΠ°Π»ΠΈΠ·Π° (18.1%), Ρ Π½Π°ΠΉ-ΡΠ΅ΡΡ ΠΏΡΠΈΡΠΈΠ½ΠΈΡΠ΅Π» Enterococci (19.5%, Ρ = 0.001). CAIE ΡΠ΅ ΠΏΡΠΈΡΠΈΠ½ΡΠ²Π° Π½Π°ΠΉ-ΡΠ΅ΡΡΠΎ ΠΎΡ Staphylococci (29.6%) ΠΈ Streptococci (12%). ΠΡΡΡΠ΅Π±ΠΎΠ»Π½ΠΈΡΠ½Π°ΡΠ° ΡΠΌΡΡΡΠ½ΠΎΡΡ ΠΈ ΡΠ°Π½Π½Π°ΡΠ° Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ½Π° ΠΈΠ½ΡΠ΅ΡΠ²Π΅Π½ΡΠΈΡ ΡΠ° Π±Π΅Π· ΡΠΈΠ³Π½ΠΈΡΠΈΠΊΠ°Π½ΡΠ½Π° ΡΠ°Π·Π»ΠΈΠΊΠ° Π² ΡΡΠΈΡΠ΅ Π³ΡΡΠΏΠΈ. ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅: ΠΠΎΠ·Π½Π°Π²Π°Π½Π΅ΡΠΎ Π½Π° ΡΡΠΈΡΠ΅ Π³ΡΡΠΏΠΈ ΠΠ ΡΠΏΠΎΡΠ΅Π΄ Π½Π°ΡΠΈΠ½Π° Π½Π° ΠΏΡΠΈΠ΄ΠΎΠ±ΠΈΠ²Π°Π½Π΅ β CAIE, HAIE ΠΈ IDUIE, ΠΈ ΡΠ΅Ρ
Π½ΠΈΡΠ΅ Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΡΡΠΈΠΊΠΈ, Π΅ Π²Π°ΠΆΠ½ΠΎ Π·Π° ΠΈΠ·Π±ΠΎΡΠ° Π½Π° Π½Π°ΡΠ°Π»Π½ΠΎ Π΅ΠΌΠΏΠΈΡΠΈΡΠ½ΠΎ Π°Π½ΡΠΈΠ±ΠΈΠΎΡΠΈΡΠ½ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ ΠΈ ΠΏΠΎΠ΄ΠΎΠ±ΡΡΠ²Π°Π½Π΅ Π½Π° ΠΏΡΠ΅Π²Π΅Π½ΡΠΈΡΡΠ°. According to the mode of acquisition, infective endocarditis (IE) is classifi ed as community-acquired (CAIE), healthcareassociated (HAIE), and injection drug useβrelated IE (IDUIE). At this stage, there are no data for Bulgaria for these three groups of patients. Objective: We set ourselves the goal of investigating IE according to the mode of acquisition and to make a clinical-instrumental characterization of the groups. Material and methods: The study is single-center, retrospective and includes 270 patients treated at the UMHAT βSveti Georgiβ β Plovdiv for the period 01.2005-12. 2021. Results: Patients with CAIE were 64.8% (175), with HAIE 26.7% (72) and with IDUIE 8.5% (23). Patients with IDUIE are younger compared to the other two groups (33; 8 years) (p = 0.000), with low comorbidity (CCI β 1, IQR β 1; p = 0.000), with most frequent right-sided involvement (p < 0.001) and with the most common causative agent being Staphylococcus aureus (p < 0.01). Patients with HAIE were the oldest (69; 18 years;), with the most comorbidity (CCI β 4; IQR β 3), with no signifi cant difference with CAIE (66; 20 years; and CCI β 3; IQR β 3). The large proportion of portal of entry for them were manipulations/ procedures (62.5%) and hemodialysis (18.1%), with Enterococci being the most common causative agent (19.5%, p = 0.001). In-hospital mortality and early surgical intervention were without signifi cant difference in the three groups. Conclusion: Knowledge of the three groups of IE according to the mode of acquisition β CAIE, HAIE and IDUIE and their characteristics is important for the choice of initial empiric antibiotic treatment and for improvement of prevention
High-sensitivity CRP levels in women with gestational hypertension, preeclampsia and in normotensive pregnant women and its correlations
Introduction: Gestational hypertension is a less investigated hypertensive disorder of pregnancy than preeclampsia, but evidence exists of an unfavourable cardiovascular profile for women after such a pregnancy.Aim: To determine serum high-sensitivity C-reactive protein (hs-CRP) levels in women with preeclampsia, gestational hypertension, and in normotensive pregnancy in order to assess the cardiovascular implications and to examine its correlations with some characteristics of women.Materials and methods: Thirty-six women with gestational hypertension, thirty-seven with preeclampsia, and fifty maternal and gestational age-matched controls were included in a single-center prospective clinical-epidemiological study. Serum hs-CRP levels were determined using ELISA method.Results: Significantly higher hs-CRP levels were found in the gestational hypertension group than in the controls (p=0.043), but not in the preeclampsia group (p=0.445). The levels between the two pathological groups did not differ significantly (p=0.247). Odds ratio for hs-CRP levels higher than the provided cut-off was 3.31 (95% CI 1.32β8.29) for the presence of gestational hypertension. In the normotensive pregnant women, the hs-CRP levels had a positive correlation with BSA, pre-pregnancy and current BMI, but such correlations were absent in the hypertensive groups. There were no correlations with the maternal or gestational age, current weight gain in any of the groups or with the highest detected blood pressure in the pathological groups. These levels did not differ according to gravidity, smoking status and smoking during pregnancy.Conclusions: Elevation of hs-CRP was more pronounced in women with gestational hypertension than in women with preeclampsia, which could indicate a different pathophysiological mechanism and a higher cardiovascular risk for those women
Acute neurological symptoms as a debut of infective endocarditis
ΠΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ·Π½ΠΈΡΡ Π΅Π½Π΄ΠΎΠΊΠ°ΡΠ΄ΠΈΡ (ΠΠ) Π΅ Π²ΡΠ·ΠΏΠ°Π»ΠΈΡΠ΅Π»Π½ΠΎ Π·Π°Π±ΠΎΠ»ΡΠ²Π°Π½Π΅ Π½Π° Π΅Π½Π΄ΠΎΠΊΠ°ΡΠ΄Π° Π½Π° ΡΡΡΡΠ΅ΡΠΎ, Π·Π°ΡΡΠ³Π°ΡΠΎ ΡΡΡΠ΄Π΅ΡΠ½ΠΈΡΠ΅ ΠΊΠ»Π°ΠΏΠΈ (Π½Π°ΡΠΈΠ²Π½ΠΈ ΠΈΠ»ΠΈ ΠΏΡΠΎΡΠ΅Π·Π½ΠΈ), Π° Π² ΠΏΠΎΡΠ»Π΅Π΄Π½ΠΈΡΠ΅ Π½ΡΠΊΠΎΠ»ΠΊΠΎ Π΄Π΅ΡΠ΅ΡΠΈΠ»Π΅ΡΠΈΡ ΠΈ Π½Π°Π»ΠΈΡΠ½ΠΈ Π²ΡΡΡΠ΅ΡΡΡΠ΄Π΅ΡΠ½ΠΈ ΠΏΠΎΡΡΠΎΡΠ½Π½ΠΈ ΡΡΡΡΠΎΠΉΡΡΠ²Π° ΠΈΠ»ΠΈ ΠΊΠ°ΡΠ΅ΡΡΠΈ. ΠΡΠΏΡΠ΅ΠΊΠΈ ΡΠ΅Ρ
Π½ΠΎΠ»ΠΎΠ³ΠΈΡΠ½ΠΈΡ ΠΏΡΠΎΠ³ΡΠ΅Ρ ΠΈ Π½Π°ΡΡΡΠΏΠ°Π½ΠΈΡ ΠΎΠΏΠΈΡ, ΡΠ°Π·ΠΈ Π±ΠΎΠ»Π΅ΡΡ Π½Π΅ ΡΠΏΠΈΡΠ° Π΄Π° Π±ΡΠ΄Π΅ ΠΎΠ³ΡΠΎΠΌΠ½ΠΎ ΠΏΡΠ΅Π΄ΠΈΠ·Π²ΠΈΠΊΠ°ΡΠ΅Π»ΡΡΠ²ΠΎ Π·Π° Π»Π΅ΠΊΠ°ΡΠΈΡΠ΅ ΠΏΠΎ ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠ΅ Π½Π° Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ°, Π»Π΅ΡΠ΅Π½ΠΈΠ΅ ΠΈ ΠΏΠΎΠ΄ΠΎΠ±ΡΡΠ²Π°Π½Π΅ Π½Π° ΠΏΡΠ΅ΠΆΠΈΠ²ΡΠ΅ΠΌΠΎΡΡΡΠ°. ΠΠ»ΠΈΠ½ΠΈΡΠ½Π°ΡΠ° ΠΊΠ°ΡΡΠΈΠ½Π° Π΅ Π½Π΅ΡΠΈΠΏΠΈΡΠ½Π° ΠΈ ΡΠ°Π·Π½ΠΎΡΠΎΠ΄Π½Π°, Ρ ΡΠ°Π·Π»ΠΈΡΠ½ΠΈ ΠΊΠ»ΠΈΠ½ΠΈΡΠ½ΠΈ βΠΌΠ°ΡΠΊΠΈβ Π½Π° Π΄ΡΡΠ³ΠΈ Π·Π°Π±ΠΎΠ»ΡΠ²Π°Π½ΠΈΡ β ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ·Π½ΠΈ, ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ½ΠΈ, Ρ
Π΅ΠΌΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ½ΠΈ, ΡΠ΅Π²ΠΌΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ½ΠΈ, Π½Π΅Π²ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ½ΠΈ ΠΈ Π΄Ρ. ΠΠΌΠ±ΠΎΠ»ΠΈΡΠ½ΠΈΡΠ΅ ΡΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ ΡΠ΅ΡΡΠΎ ΡΠ° ΠΏΡΡΠ²Π° ΠΈΠ·ΡΠ²Π° Π½Π° Π±ΠΎΠ»Π΅ΡΡΡΠ°, ΠΊΠ°ΡΠΎ Π½Π°ΠΉ-ΡΠ΅ΡΡΠΎ ΡΠ° ΠΌΠΎΠ·ΡΡΠ½ΠΈ. ΠΡΠ΅Π΄ΡΡΠ°Π²ΡΠΌΠ΅ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅Π½ ΡΠ»ΡΡΠ°ΠΉ Π½Π° 29 Π³. ΠΆΠ΅Π½Π°, Ρ ΠΎΡΡΡΠ° Π½Π΅Π²ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ½Π° ΡΠΈΠΌΠΏΡΠΎΠΌΠ°ΡΠΈΠΊΠ° ΠΊΠ°ΡΠΎ ΠΏΡΡΠ²Π° ΠΏΡΠΎΡΠ²Π° Π½Π° ΠΠ. Π’ΠΎΠ·ΠΈ ΡΠ»ΡΡΠ°ΠΉ ΠΎΡΡΠ°Π·ΡΠ²Π° Π½Π΅ΡΠΈΠΏΠΈΡΠ½Π°ΡΠ° ΠΊΠ»ΠΈΠ½ΠΈΡΠ½Π° ΠΏΡΠ΅Π·Π΅Π½ΡΠ°ΡΠΈΡ Π½Π° Π·Π°Π±ΠΎΠ»ΡΠ²Π°Π½Π΅ΡΠΎ, Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ΡΠΎ Π½Π° Π½ΠΎΠ²ΠΈΡΠ΅ ΠΎΠ±ΡΠ°Π·Π½ΠΈ ΠΌΠΎΠ΄Π°Π»Π½ΠΎΡΡΠΈ Π² ΠΏΡΠ΅ΡΠΈΠ·Π½Π°ΡΠ° Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ° Π½Π° Π½Π΅Π²ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ½ΡΠ΅ ΡΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ, ΠΊΠ°ΠΊΡΠΎ ΠΈ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ΡΠΎ Π·Π° Π²ΡΠ΅ΠΌΠ΅ΡΠΎ Π½Π° ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠ²Π½Π°ΡΠ° ΠΈΠ½ΡΠ΅ΡΠ²Π΅Π½ΡΠΈΡ, ΠΊΠΎΠ³Π°ΡΠΎ Π΅ ΠΏΠΎΠΊΠ·Π°Π½Π°. ΠΡΡΠ°Π²Π° ΠΎΡΠ²ΠΎΡΠ΅Π½ Π²ΡΠΏΡΠΎΡΡΡ Π·Π° ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠ°ΡΠ° Π½Π° ΠΠ ΠΏΡΠΈ ΡΠΌΠ΅ΡΠ΅Π½ΠΎΡΠΈΡΠΊΠΎΠ²ΠΈΡΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ, ΠΊΠ°ΠΊΠ²ΠΈΡΠΎ ΡΠ° ΡΠ΅Π·ΠΈ Ρ ΠΌΠΈΡΡΠ°Π»Π΅Π½ ΠΊΠ»Π°ΠΏΠ΅Π½ ΠΏΡΠΎΠ»Π°ΠΏΡ ΠΈ Π±ΠΈΠΊΡΡΠΏΠΈΠ΄Π½Π° Π°ΠΎΡΡΠ½Π° ΠΊΠ»Π°ΠΏΠ°. Infective endocarditis (IE) is an infl ammatory disease of the endocardium of the heart affecting heart valves (native or prosthetic) and, in the last few decades, also available intracardiac permanent devices or catheters. Despite technological progress and accumulated experience, this disease continues to be a huge challenge for doctors in terms of diagnosis, treatment and improvement of survival. The clinical picture is atypical and heterogeneous, with different clinical "masks" of other diseases β infectious, oncological, hematological, rheumatological, neurological, etc. Embolic complications are often the fi rst manifestation of the disease and are most often cerebral. We present a clinical case of a 29-year-old woman with acute neurological symptoms as a fi rst manifestation of IE. This case refl ects the atypical clinical presentation of the disease, the importance of new imaging modalities for the precise diagnosis of neurological complications, and the decision on the timing of operative intervention when indicated. The question of IE prophylaxis in moderate-risk patients, such as those with mitral valve prolapse and bicuspid aortic valve, remains open