Infective endocarditis at the patients at hemodialisis

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.