What are the clinical manifestations of native valve endocarditis?

Native valve endocarditis is commonly seen in patients with underlying new illnesses who often have infectious symptoms, heart murmurs, embolic symptoms, and skin lesions. The details are as follows.

 

(1) Fever: Fever is the most common symptom of infective endocarditis, except for some elderly patients or patients with severe heart and renal failure, almost all have fever. In subacute cases, the onset is insidious, and there may be non-specific symptoms such as general malaise, fatigue, anorexia, and weight loss. , The lowest body temperature is still higher than normal, often accompanied by headache, back pain and muscle and joint pain. Acute cases showed a process of fulminant sepsis, high fever and chills, and often sudden heart failure.

 

(2) Heart murmurs: 80% -85% of patients have pathological murmurs.

 

(3) Peripheral signs (skin and mucous membrane lesions): mostly non-specific, rare in recent years, including the following. ①Petechiae, which can appear in any part, are common in the skin above the clavicle, oral mucosa and palpebral conjunctiva, and are more common in the elderly; ②Linear hemorrhage under the finger and toenail; ③Roth's spot is an oval hemorrhage of the retina, and its center is White, more common in subacute infections; ④Osler's nodules, pea-sized red or purple painful nodules on the pads of fingers and toes, more common in subacute cases; ⑤Janeway lesions, 1 to 4 mm in diameter on the palms and soles Painless hemorrhagic erythema, mainly seen in acute patients.

 

(4) Arterial embolism: Arterial embolism caused by vegetation shedding accounts for 20% to 40%, and embolism can occur in any part of the body. The brain, heart, spleen, kidney, mesentery and limbs are the clinically seen systemic arterial embolism sites. The incidence of cerebral embolism is 15% to 20%. Pulmonary embolism is common in patients with congenital heart disease such as atrial septal defect, ventricular septal defect, patent ductus arteriosus, or right endocarditis. Such as pulmonary embolism caused by the shedding of tricuspid vegetations, sudden cough, dyspnea, hemoptysis or chest pain may occur.

 

(5) Non-specific symptoms of infection: ① splenomegaly accounts for 10% to 40%, more common in patients with a course of disease greater than 6 weeks, and rare in acute patients; ② anemia is more common, especially in subacute patients, with pallor and dysphagia. sweat. Mostly mild to moderate anemia, advanced patients have severe anemia.