โรคติดเชื้อของหัวใจ กับการรักษาในหลายวิธี

We know well that heart disease is one of the top causes of death worldwide. We are generally familiar with heart failure or cardiac valve stenosis or regurgitation, coronary artery stenosis, rupture and obstruction; myocardial ischemia and cardiac arrhythmia, or electrical disease of the heart.
However, many people probably are bewildered by and have never heard about heart infection and what it actually is. Can a heart get infection? Today, Dr. Kittichai Lueangthawibun, Medical Specialist in Cardiothoracic and Cardiovascular Surgery of the Heart Center of Phyathai 2 Hospital will provide answers and clear some doubts with detailed explanations.
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<h2>Learn about Heart Infection</h2>
Heart infection is a disease that is sporadically encountered in Thailand. Infections are usually caused by bacteria, tuberculosis and viruses. For the parts of the heart that can become infected, the heart valves often develop bacterial infections caused by tooth and gum infections that spread and cause septicemia before reaching the heart valves, especially if the heart valves already have some abnormalities, for example:
<ul>
<li>Infection in heart valves with a chronic rheumatic disease is often caused by gram-positive bacteria such as streptococcus.</li>
<li>Meanwhile, people who intravenously inject narcotics often develop heart valve infections on the right side, particularly the tricuspid valve. Infection is usually caused by staphylococcus.</li>
<li>Patients with artificial heart valves are also at risk of developing infections at their replacement valves.</li>
</ul>
Infection causes heart valve regurgitation. Parts of the disease that are attached to the heart valve might detach and block a cerebral artery, thereby causing disability. Infection caused by serious diseases can lead to an abscess to form in the heart, which can cause the electrical system of the heart to malfunction, thus leading to potentially-fatal slowing of the heart rate or cardiac arrest. Otherwise, infection might spread in the bloodstream, forming abscesses in the lungs and other various organs.
 
<h2>Frequently Encountered Heart Infections </h2>
Frequently encountered heart valve infections are infections of the left side, i.e., the aortic and mitral valves, and as heart valve regurgitation occurs, there can be failure on the left heart valves, producing such symptoms as fatigue and inability to lie down horizontally. Otherwise, the infection enters the circulatory system until clogging the cerebral arteries, internal organs and the arms and legs, etc.
Infections at the tricuspid valve often causes valve regurgitation, leading to failure on the right side of the heart, ascites and jugular venous distention, and the infection might spread to the lungs, causing pulmonary abscess or small air sacs inside the lungs that result from destruction of lung tissues by the infection. Surgery often involves heart valve replacement. In older patients, valves derived from tissues might be used. Otherwise, if the patient is younger, a metal valve might be used instead, for example, if the patient is less than 65 years old, or else a heart valve from a deceased person can be used, which is usually a donated aortic valve. Known as homograft, it is beneficial of having little risk for recurrent infection. However, its down side is that it might become worn or damaged after a long period of time such as after 10 years or more.
<h2>Diagnosis and Treatment of Pericardium Infections</h2>
<h2>Pericardium infections can be caused by…</h2>
Bacterial infection such as staphylococcus or tuberculosis. The former infection usually occurs acutely, causing the patient to experience high fever and severe illness with abscess being frequently encountered in the pericardium. It is potentially fatal because the abscess might exert pressure upon the heart and prevent deoxygenated blood from flowing back to the right side of the heart and oxygenated blood from easily flowing into the left side of the heart.
Diagnosis usually relies upon x-ray imagery showing heart enlargement, which is confirmed by use of an echocardiogram and extraction of abscess fluid for testing, staining and germ culture to determine antibiotic sensitivity in order to choose the right medication treatment.
Then the abscess has to be drained by inserting a drainage tube through the pericardial cavity. If the pus is thick or distributed across multiple abscesses, it might be necessary to perform surgery on the pericardium to remove anterior tissues in order to drain the pus, reduce infection and prevent cardiac fibrosis in chronic cases.
As for tuberculosis, the pericardium might develop infections that spread from the lungs or lymph nodes afflicted by tuberculosis. During the acute stage, symptoms may not be visible. However, symptoms often occur during the chronic stage, when the patient often experiences constrictive pericarditis, and even after the doctor has prescribed medications to treat tuberculosis to the point that signs of the disease has disappeared, fibrosis symptoms still might not improve. As result, it might be necessary to perform surgery to remove pericardiac tissues and fibrous tissues from the heart in order to alleviate symptoms in the right chambers of the heart where the constriction has occurred. Accordingly, the co-presenting symptoms of this condition include abdominal distension, swelling of the legs, hypotension, fatigue and loss of appetite.
Viruses that frequently infect cardiac muscles include the adenovirus and enterovirus such as the coxsackie virus, which causes acute failure in the left side of the heart, along with hypotension and ischemia in different organs of the body that can lead to patient death.
Today, we use the ECMO to support the circulatory system and provide treatment by using antiviral medications. Even though desirable results are not guaranteed, because many patients can recover on their own if they do not die in the initial stages, use of the circulation support system in necessary cases can save patients’ lives

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