Abstract:
Introduction: Infective endocarditis (IE) at patients on hemodialysis (HD) is 10-18 times higher than
in the general population, caused by arterio-venous fistula or central catheter, increased susceptibility to
infections and renal failure. HD patients with valvular calcification often presents (28% - 36%
calcification Vao and VM), fistulae and synthetic venous catheters 7.6% being the gateway to infection.
Severe complications frequently occur in staphylococcal IE at patients on HD: pulmonary edema (82-
100%) embolic syndrome, cerebral often (9-17%) lung abscess. High mortality in the first year of
evolution of the disease 45-75% compared with 25-52% in-hospital death.
Clinical case: Patient X. 64 years old. Diagnosis: chronic renal disease. Chronic diffuse
glomerulonephritis. End-stage chronic renal failure. Hypertension gr. III very high additional risk. CF II
NYHA at dialysis 1.5. months.Results: subfebrility, palpitations, inspiratory shortness of breath, sore legs, pain in lombar,
asthenia. Objective: skin petechiae, limited verbal contact, right hemiparesis, rhythmic heart sounds,
TA-105/70 mmHg. FCC-109 c / min. Anemia (Hb 62 g / l), thrombocytopenia, lymphopenia,
leucocytozis and increased ESR. Blood biochemistry: hyperuricaemia, hipercreatininemie.
Staphylococcus aureus blood culture positive. ECG: Sinus tachycardia 100 c / min, ventricular premature
beats, atrioventricular block gr.I. AEC left deviation. LV hypertrophy EcoCG: Expansion AS, moderate
AD, LV and RV. LV hypertrophy EF - 49%. VAO failure gr.I. VM failure gr.II. VTS failure gr.II.
Impaired VAP gr.I. Moderate pulmonary hypertension.
Treatment: HD, antimicrobial, antifungal, vascular rheology.
Conclusions: patients with HD who develop IE onset of congestive heart failure, peripheral
stigma, developing hypotension, staphylococcal etiology, embolic complications at onset in disease
presents a reserved prognosis.
Description:
Medical Clinic nr.3, Department Internal Medicine, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016