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Osler's nodes are reddish, nodular skin manifestations up to 1.5 cm in diameter, painful when pressed. Osler's nodes appear most often on the palms, fingers, soles, and under the nails. Usually these nodules disappear without a trace after a few days or a few hours, but sometimes they necrosis and suppuration occur.

Osler nodes are pathognomonic for classic protracted infective endocarditis, but appear infrequently (in 10% of cases). Joint pain occurs in 20% of patients and is sometimes accompanied by swelling of the joints. Large joints are most often affected, but small joints of acticin medication and hands may be affected. In 10-40% of patients, thickening of the terminal phalanges of the fingers in the form of drumsticks develops. Bone pain occurs quite often. In this case, there is pain in the sternum, sacrum, femur, and lower leg.

These pains occur as a result of periostitis, hemorrhages in the vessels of the periosteum. With successful treatment, bone pain decreases or disappears if the process affects only soft tissue. When the periosteum and bone are affected, pain sometimes remains despite recovery. Palpitations and pain in the heart area are usually absent at the beginning of the disease; later they appear in almost all patients. Pain in the heart region varies greatly in intensity, duration, location and nature.

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Pain in the heart area can also be a manifestation of myocarditis - an almost constant companion of IE. With secondary infective endocarditis, it is possible to detect changes in the nature and location of cardiac murmurs.

Their duration, timbre and strength change. Noises become more intense due to buy acticin online in the valve apparatus and the development of anemia. Heart sounds becomedeaf, often weakens and then disappears the second sound in the aorta due to insufficiency of its valves. Against the background of old noises, new noises may appear. Most often, diastolic murmur occurs in the aorta as a result of aortic valve insufficiency. It is not uncommon that peculiar noises suddenly appear, the so-called “bird squeak”, which are caused by perforation of the valve leaflets, interventricular septum, or rupture of the papillary muscle.

In primary IE, especially acute, there is no heart murmur in 30% of patients. Only later, after several weeks or months, signs of damage to the heart valves appear. Sometimes a heart murmur cannot be heard at all. In such cases, the presence of endocarditis of the right heart should be suspected.

Under the influence of therapy, fibrin and collagen deposits on the valve leaflets increase, followed by calcification of the lesions. Subsequently, scarring and deformation of the valves occurs with the formation of heart defects. This whole process takes 2-3 months. Myocarditis almost always accompanies the development of IE. It is characterized by palpitations, dullness of heart sounds and weakening of heart murmurs, frequent development of heart failure, as well as various severe rhythm and conduction disturbances. Electrocardiographically, extrasystole, paroxysmal tachycardia, atrial fibrillation and AV block are detected up to the development of Adams-Stokes-Morgagni syndrome. Characterized by a decrease in voltage and a shift in the S-T interval.

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Damage to the pericardium in the form of pericarditis occurs in 10% of patients, and, as a rule, is a complication of uremia or myocardial infarction. Heart failure is a common and serious complication of IE. It rarely develops at the onset of the disease, but subsequently appears in almost all patients. It begins with symptoms characteristic of permethrin cream. tachycardia, shortness of breath, attacks of cardiac asthma, gallop rhythm. Later, right ventricular failure also occurs. Total heart failure develops.

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Heart failure is associated with destruction of heart valves, myocarditis, as well as myocardial abscessation and the development of infarction. This heart failure is characterized by severe course, lack of effect from cardiac glycosides and is the cause of death even in cases where the infection is eliminated. Valvular vegetations are easily destroyed, forming multiple emboli, which lead to the development of infarctions of various organs; most often, infarctions of the kidneys, lungs, brain, spleen, and heart develop.

Thromboembolism of peripheral and intestinal vessels is possible. The main symptom of vascular blockage is a sudden sharp pain in the affected organ caused by ischemia. The pain is accompanied by a more or less pronounced collaptoid reaction, a rise in temperature, leukocytosis, an increase in ESR and, naturally, dysfunction of organs. Damage to buy permethrin online vessels and a latent tendency to hemorrhage can be identified by the Konchalovsky-Rumpel-Leede symptom. It lies in the fact that when the shoulder is compressed by a tourniquet or tonometer cuff, multiple petechiae appear on the flexor surface of the elbow and distally.


Capillary fragility can also be detected by mild trauma to the skin - “pinch” syndrome. Kidney damage in IE manifests itself in the form of infarctions, focal and diffuse nephritis and renal failure. Kidney infarction is diagnosed by an attack of sharp or dull pain in the lumbar region with a positive Pasternatsky sign.

At the same time, macro- and microhematuria, proteinuria, transient arterial hypertension, and increased body temperature are noted. These symptoms usually disappear within a few days. Focal nephritis manifests itself as isolated urinary syndrome. microhematuria, albuminuria, cylinduria.
Characterized by the formation of renal edema, renal failure and arterial hypertension. It should be taken into account that since diastolic pressure in patients with IE due to aortic valve insufficiency is usually low (10-15 mm Hg), then its increase to figures of 60-80 mm Hg, and even higher, may indicate the development of diffuse nephritis.