Osler's nodules on the fingertips

Introduction Vasculitis occurs in the subcutaneous arterioles, forming a purple-red, large-grain, and tenderly nodular nodule on the palm of the fingertip, called the Osler nodule. This symptom is more common in subacute infective endocarditis. Subacute infective endocarditis is much more common and important than in acute cases. Subacute infective endocarditis occurs mostly in rheumatic valvular disease, such as mitral and aortic regurgitation, and certain congenital heart diseases such as ventricular septal defect, patent ductus arteriosus and bicuspid aorta Organic heart disease such as the valve. Most occur in rheumatic heart valve disease, such as mitral and aortic regurgitation, and some congenital heart disease, such as ventricular septal defect, patent ductus arteriosus and bicuspid aortic valve and other organic heart disease.

Cause

This symptom is more common in subacute infective endocarditis.

Subacute infective endocarditis is much more common and important than in acute cases. Subacute infective endocarditis occurs mostly in rheumatic valvular disease, such as mitral and aortic regurgitation, and certain congenital heart diseases such as ventricular septal defect, patent ductus arteriosus and bicuspid aorta Organic heart disease such as the valve. Most occur in rheumatic heart valve disease, such as mitral and aortic regurgitation, and some congenital heart disease, such as ventricular septal defect, patent ductus arteriosus and bicuspid aortic valve and other organic heart disease. Individuals also occur on the basis of the original no heart disease. The pathogens of this disease are mostly conditional pathogens, such as Streptococcus viridans, Staphylococcus aureus, Fusarium oxysporum and Enterococcus.

A few are mold infections, of which Candida is more. Pathway of infection: Streptococcus viridans infection is often associated with oral surgery. Enterococcus often occurs after urinary tract surgery or abortion. Staphylococcus, Gram-negative bacilli, and mold infections often occur after intracardiac surgery.

an examination

Related inspection

M-mode echocardiography (ME) Urine routine Doppler echocardiography

Subacute infective endocarditis is slow onset, initial clinical manifestations can be atypical, especially in elderly patients, but most patients gradually show characteristic manifestations. Any patients with heart disease have unexplained fever for more than 1 week, should consider this disease Possibly, fever often is irregular low fever or moderate fever, but there are also high heat chills, joints and low back pain, positive hemoglobin anemia, clubbing and splenomegaly, the heart can change in addition to the original heart disease. Or new murmurs, variability, and heart failure, mainly during endocarditis, valve perforation, chordae rupture, functional stenosis, aortic sinus rupture and myocardial inflammation due to coronary embolism or Due to myocardial infarction, patients also have migratory infections and aneurysm formation. Embolization can cause various clinical manifestations. For example, splenic embolism can cause severe pain in the left upper abdomen. Renal embolism can cause hematuria and renal colic. Cerebral embolism can cause hemiplegia. , aphasia, coma and subarachnoid hemorrhage and skin mucosal hemorrhage or streaking hemorrhage, Osler nodules at the fingertips, retinal hemorrhage.

First, blood culture: positive can determine the diagnosis, and provide a basis for the selection of antibiotics.

Second, blood: there is progressive anemia, white blood cell count is normal or increased.

Third, the blood sedimentation increased.

Fourth, urine routine: proteinuria and hematuria, about 1/3 of patients with advanced renal insufficiency.

5. Echocardiography: There are neoplasms in the heart valve or endocardial wall, and abnormal manifestations of inherent heart disease.

Differential diagnosis

Differential diagnosis of Osler nodules at the fingertips:

1. Small granules on the nails: Small granules on the nails indicate the symptoms of small granules on the nails.

2, the central part of the nail bulge: the central part of the bulge refers to the middle part of the nail bulge, the body is warned, the respiratory system is abnormal, if the bulge is particularly obvious, it indicates that the liver is faulty.

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