小结
定义
感染性心内膜炎 (Infective endocarditis, IE) 是累及心脏的心内膜表面的感染，包括瓣膜结构、腱索、间隔缺损的部位或心内膜。[1][Figure caption and citation for the preceding image starts]: 亚急性细菌性心内膜炎累及二尖瓣的大体病理图CDC/Dr Edwin P. Ewing, Jr；经许可后使用 [Citation ends].
病史和体格检查
关键诊断因素
- 发热/寒战
- 盗汗、身体不适、乏力、食欲不振、体重减轻、肌肉痛
- 虚弱
- 关节痛
- 头痛
- 呼吸短促
- 脑膜刺激征
- 心脏杂音
- Janeway 损害
- Osler 结节
- Roth 斑
其他诊断因素
- 指甲下线状出血
- 皮肤坏死
- 胸痛
- 背痛
- 上腭瘀斑
危险因素
- 感染性心内膜炎的既往病史
- 存在人工心脏瓣膜修复
- 某些类型的先天性心脏病
- 心脏移植后（心脏瓣膜病变患者）
- 存在心脏植入式电子设备或血管内导管（例如血液透析）
- 获得性退行性瓣膜疾病
- 二尖瓣脱垂或僧帽瓣脱垂
- 肥厚型心肌病
- 静脉毒品使用
诊断性检查
首要检查
- 全血细胞计数（FBC）
- 血清生化检查和血糖检测
- 尿液分析
- 血液培养
- 心电图（ECG）
- 超声心动图
需考虑的检查
- 类风湿因子
- 红细胞沉降率
- 补体水平
- 心脏 CT
- 头部 MRI
治疗流程
疑似感染性心内膜炎
自体瓣膜：确诊的心内膜炎
人工瓣膜：确诊的心内膜炎
有感染性心内膜炎高风险
撰稿人
作者
Tracey Keteepe-Arachi, BSc (Hons), MBBS, MRCP (UK)
Cardiology Specialist Registrar and Clinical Research Fellow
Department of Cardiovascular Sciences
St George's Hospital Medical School
University of London
London
UK
利益声明
TKA declares that she has no competing interests.
Aneil Malhotra, MA (Hons), MSc, MB BChir, MRCP (UK)
Cardiology Specialist Registrar and Clinical Research Fellow
Department of Cardiovascular Sciences
St George's Hospital Medical School
University of London
London
UK
利益声明
AM is an author of a number of references cited in this topic.
Michael Papadakis, MD, MRCP (UK)
Clinical Lecturer in Cardiology
St George's University of London
London
UK
利益声明
MP declares that he has no competing interests.
鸣谢
Dr Tracey Keteepe-Arachi, Dr Aneil Malhotra, and Dr Michael Papadakis would like to gratefully acknowledge Professor Sanjay Sharma, Dr Jason C. Schultz, Dr Nisha K. Lassi, and Dr Nandan S. Anavekar, previous contributors to this topic. JCS, NKL, NSA, and SS declare that they have no competing interests.
同行评议者
Vandana Desai, MD
Professor of Pediatrics
SMIMER Hospital
Gujarat
India
利益声明
VD declares that she has no competing interests.
Lucieni Oliveira Conterno, MD, PhD
Director
Clinical Epidemiology Unit
Marilia Medical School
Sao Paulo
Brazil
利益声明
LOC declares that she has no competing interests.
Andrew Wang, MD
Associate Professor of Medicine
Director, Cardiovascular Disease Fellowship Program
Duke University Medical Center
Durham
NC
利益声明
AW declares that he has no competing interests.
鉴别诊断
- 风湿热
- 心房黏液瘤
- Libman-Sacks 心内膜炎
更多 鉴别诊断指南
- 草绿色链球菌感染性心内膜炎的预防
- ACR 适宜性标准：感染性心内膜炎
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