Endocarditis

=Endocarditis=

Western Diagnosis Microbial infection of endocardium

A. fever, murmurs, petechiae, emboli, vegetations, valvular incompetence or obstruction, myocardial abscess, mycotic aneurysm B. ABE from staph, Group A beta hemolytic strep, pneumococcus, gonococcus C. SBE from strep: often on abN valves from asx bacteremia from infected gums, GI, or GU

Signs and Symptoms
1. SBE has insidious onset 2. ABE has similar sx but rapid onset 3. low grade fever, chills 4. nightsweats 5. fatigue 6. wt loss 7. arthralgias 8. cardiac murmurs 9. tachycardia 10. petechiae over upper trunk 11. painful erythematous subcutaneous nodules at tips of fingers - Osler’s nodes 12. splinter hemorrhages under nails 13. clubbing of fingers 14. emboli - stroke, MI, hematuria 15. encephalopathy, brain abscess

Lab
1. suspect in anyone with fever and murmur 2. immediate blood culture

Diagnosis
echocardiogram if underlying valvular disease

Treatment
Always fatal if untreated a. for pts with valvular disease or other predisposition to IE: IV drug use, dx procedures with vascular lines, elderly b. oral procedures c. GI, GU infections d. cardiac valvular surgery e. antibiotics a. maintain high serum levels of antibiotic b. penicillin, erythromycin, ampicillin, amoxicillin, gentamycin, vancomycin
 * Prophylaxis**
 * Treatment**

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IBIS:

Definition:
bacterial infection of the endocardium or heart valves, recognized by systemic symptoms, tendency for embolism, and endocardial vegetations; also termed "bacterial endocarditis"

Etiology:
The associated microorganism of SBE is typically alpha-hemolytic streptococcus, although other strep strains and staph aureus (especially in patients with prosthetic valves) are increasing in frequency as the cause. Bacteremia is often associated with infection following, oral cavity infections and operative procedures. Congenital or acquired malformed or damaged heart valves are highly susceptible to the disease. It is most common in people with preexisting valvular heart disease.

Nutrition:
eating principles: • eat as little as possible • increase foods rich in Vitamins C, A and E, foods rich in Magnesium • increase fluids: diluted vegetable juices, broths, herbal teas • low sugar, low fat diet • diet high in whole complex carbohydrates • protein 12-15% diet • low cholesterol/cholesterol foods) • low sodium/sodium-restricted diet • vegetarian cleansing diet or short fasts • Fasting, General Sample Diet, General Guidelines for Eating, Sample Vegetarian Diet

avoid: • meat, alcohol, hot sauces, spicy foods, fried foods, fatty foods, rich foods, salty foods • heavy protein foods, fats, meats, vinegars, shellfish, sugars

Botanicals
• Aconitum napellus (toxic): endocarditis with full bounding pulse; fever, restlessness, sharp cutting pain on left side (Harper-Shove, p. 133) • Adonis vernalis: endocarditis (Harper-Shove, p. 133) • Cimicifuga racemosa: endocarditis with frontal or vertex headache; rheumatism, pain under left nipple extending down left arm (Harper-Shove, p. 133) • Crataegus oxyacantha: cardiotonic, after condition is controlled; endocarditis (Ellingwood, p. 218) • Lycopus virginicus: endocarditis (Harper-Shove, p. 133) • Selenicereus grandiflorus (toxic): chiefly a functional remedy; constrictive cardiac pain, valvular disease (Felter and Lloyd, p. 375) • Spigelia marilandica (toxic): endocarditis with severe pain in left side, violent blowing sound at apex of heart (Harper-Shove, p. 133) • Taraxacum officinale: tonic: after condition is controlled • Veratrum viride (toxic): endocarditis with full, hard and tense pulse; great muscular excitement (Harper-Shove, p. 133)

Chinese Formulae
• Tian Wang Bu Xin Dan (Tien Wang Pu Hsin Tan) (patent): Kidney Yin Xu (Deficiency) and Heart Yin Xu (Deficiency) (Zhu, p. 321) • Wan Shi Niu Huang Qing Xin Wan (patent): Pericardium Invaded by Heat. (Zhu, p. 132)

Acupuncture
after assessing the person and palpating, consider these patterns: Kidney Yin Xu (Deficiency) and Heart Yin Xu (Deficiency); Pericardium Invaded by Heat; disharmony of the Jue Yin (Pericardium and Liver); dysfunction of the Yin Wei Mai (Yin Linking Vessel) and/or Chong Mai (Penetrating Vessel)

» therapeutic note: consider the possible roles of a subacute infective process and depleted immune system as causal or contributing factors; such a focal infection could be lingering in the sinuses, digestive tract or other site(s); see also, "sinusitis"

» illustrative and related combinations: • PC-6 and Ht-7: regulate and harmonize the Heart and Pericardium (Finkelstein, p. 59) • PC-6, PC-5, Sp-10 and Kd-7: regulate Qi in Pericardium, Spleen and Kidney (Finkelstein, p. 59) • PC-8 and PC-6: clear Heat and disperse Heat from the Heart and Pericardium (Finkelstein, p. 60) • PC-7 and PC-8 (-): reduce Fire of the Pericardium and clear Fire of Heart (Finkelstein, p. 59) • CV-17 and TW-10: treat blockage of the chest with heart pain (Shanghai, p. 177) • CV-14 and UB-15: remove Obstruction of Heart Qi circulation to reduce Fire and ease the Mind (Finkelstein, p. 90); treat irritability of the Heart (Shanghai, p. 178) • CV-14 and PC-6: expand the chest and diaphragm (Finkelstein, p. 90 • CV-14 and CV-17: for "diaphragmatic pain accompanied by rheum accumulations" (Ellis, et al, 1988, p. 358)

Homeopathy
• Aconitum napellus: sudden onset; severe anxiety; pulse strong, full, hard; lies on back with raised shoulders; constriction of chest; palpitation, feeling as if boiling water was poured on chest • Adonis vernalis: rheumatic endocarditis; irregular cardiac action; constriction and vertigo; pulse rapid and irregular • Arsenicum album: endocarditis with restlessness; agony and tingling of fingers of left hand; severe paroxysms of palpitation or attacks of syncope; heart disease with emaciation • Aurum metallicum: endocarditis with loud endocardial bruits of fluttering action of heart, or sudden jerks through the heart • Bryonia: palpitation of heart, frequently violent and with oppression of chest • Cactus grandiflorus: palpitation lying on left side; subnormal temperature; with mitral insufficiency; together with violent and rapid action; constriction; very acute pains and stitches in heart • Ceanothus: palpable spleen, < lying on left side • Colchicinum: severe oppressive pain with dyspnea; great prostration; trembling in precordial area; internal coldness; pulse small, slow and weak; heart impulse strong • Kalmia: < leaning forward and lying on left side; slow and feeble pulse; cold sweat; chill runs over back; propped up in bed, with anxious expression of face; livid hue of countenance; visible, tumultuous and very rapid action of heart; after acute rheumatism • Lachesis: cramplike pain in precordial region, causing palpitation with anxiety; dread of going to sleep on account of marked aggravation of sleep; can bear no pressure on throat or chest; must sit or lie on right side • Naja: damaged heart after infectious disease; cardiac cough: irritating, dry with sense of choking and grasping at throat; septic; pulse irregular in force; feeling of weight on heart; dragging and anxiety in precordia • Spigelia: stitching pain, stabbing pain on deep inspiration; pain synchronous with heart beat; > lying right side; insufficiency of mitral valve; pulse weak and irregular • Spongia tosta: rheumatic endocarditis; loud blowing with each heartbeat; rapid and violent palpitation with dyspnea; cannot lie down; also feels best in horizontal position; awakened suddenly after midnight with pain and suffocation; is flushed, hot and frightened to death • Staphylococcinum: from over work, worry, lack of proper food, heredity, stress; where staphylococcus is the chief bacterial factor • Zincum metallicum: splinter-like pain in throat at intervals; < lying left side, > warmth; sudden spasmodic bursting sensation about heart; irregular movements of heart; rapid pulse

Subtle Support
• notes: A, A#, B, C, C#, D, D#, E, F#, G, G#

• chords: dominant 7th, diminished 7th, A Major, A# Major, C Major, G Major, G# Major (Gimbel, p. 116)

cardiovascular: • The Barcarole • The Blue Danube • Chopin's A minor Waltz • Tango music • Humoresque • Cui's Orientale • Song of India • Donna e Mobile • Oley Speak's Sylvia (Heline, p. 18)

Mind/Body
• Heart represents center of love and security. (Hay, 1984, p. 168) • inflammation: fear; inflamed thinking; seeing red; anger and frustration about conditions in one's life (Hay, 1984, p. 170-1)

Chinese psychophysiology: • Heart ~ Xin houses the Shen (Spirit) and reveals itself through the brightness in the eyes; governs Fire and Heat; rules the Xue (Blood) and its vessels and directs the circulation; opens into the tongue and controls speech; and relates to the integration of the organs and the personality. » Healthy expressions are warmth, vitality, excitement, inner peace, love, and joy. » Heart Xu (Deficiency) signs include sadness; absence of laughter; depression; fear; anxiety; shortness of breath (Seem, p. 28); cold feeling in the chest and limbs; palpitations; cold sweat; inability to speak; memory failure; nocturnal emissions; and restless sleep. Chronic Yin Xu (Deficiency) predisposes to Empty Fire, acute and chronic. » Heart Shi (Excess) signs include false or facile laughter; sobbing; agitated spirit; insomnia (Seem, p. 28); frightful dreams; anxiety; tongue feels numb and heavy; heavy chest; hot sweat; and orange-colored urine. » The Heart is the Emperor of the bodily realm so that when the Heart is disturbed all the other organs will be disrupted.

• Pericardium ~ Xin Bao is the Minister who protects the Heart, the Emperor, and maintains the order of the Heart energy; and as such may be adversely affected by emotional stresses internally or invasion of Heat externally. The Pericardium is said to be the origin of joy and sadness. » Healthy expressions are joy, happiness, and healthy relationships. » Weakness, dysfunction, and illness are associated with confusion, delirium, nervousness, and psychosis. » Mental signs of Pericardium channel disorders include depression, sexual perversion, aversions, and phobias. (Seem, p. 28)

• Kidney ~ Shen stores Jing (Essence) and governs birth, growth, reproduction, development, and aging; houses the Zhi (Will); expresses ambition and focus; provides the nourishing and stabilizing qualities of Yin and Water that balance the Yang and the Fiery qualities of the Heart; and displays the effects of sexual dissipation, overwork, aging, chronic degenerative processes, and extreme stress. » Healthy expressions are gentleness, groundedness, and endurance. » Kidney Xu (Deficiency) signs include indecisiveness; confused speech; dreams of trees submerged under water; abundant sweating (Seem, p. 28); fearfulness; apathy; chronic fatigue; discouragement; scatteredness; negativity; impatience; difficult inhalation; low sex drive; lumbago; sciatica; and musculoskeletal irritation and inflammation, especially when worse from touch. As always, chronic Yin Xu (Deficiency) predisposes to Empty Heat and/or acute inflammation. » Intense or prolonged fear depletes the Kidney. Often chronic anxiety may induce Xu (Deficiency) and then Fire within the Kidney. (Maciocia, p. 250) Overwork, sexual dissipation, parenting, simple aging, and a sedentary or excessively indulgent lifestyle all contribute significantly to Kidney Xu (Deficiency).