感染性心內膜炎
（Infective endocarditis，簡稱IE）
是一種嚴重的心臟感染，通常是由於細菌或真菌等微生物侵入心臟內膜所致。這些微生物會在心臟瓣膜上形成贅生物，進而導致心臟功能受損，甚至引起全身性的感染。
Infective endocarditis (IE) is a serious heart infection typically caused by bacteria or fungi invading the endocardium. These microorganisms can form vegetations on heart valves, leading to impaired heart function and even systemic infection.
引起感染性心內膜炎的常見病原體
Common pathogens causing infective endocarditis
草綠色鏈球菌 (Viridans streptococci)
金黃色葡萄球菌 (Staphylococcus aureus)
凝固酶陰性葡萄球菌 (Coagulase-negative staphylococci)
腸球菌 (Enterococci)
念珠菌 (Candida)
臨床表徵Clinical Manifestations
全身性症狀： 發燒、疲倦、體重減輕、夜間盜汗(發燒型態為回歸熱-感染源不段釋放內毒素)
Systemic: Fever, fatigue, weight loss, night sweats (often with a spiking fever pattern suggestive of recurrent bacteremia).
心臟表現： 新出現或改變的心雜音(心臟瓣膜上的贅生物會導致瓣膜功能異常)、心衰竭
Cardiac: New or changing heart murmur, heart failure.
神經系統表現： 腦栓塞(心臟內的贅生物脫落，可隨血液循環至腦部)、偏癱、失語症
Neurologic: Stroke, hemiparesis, aphasia.
皮膚黏膜表現： 奧斯勒結節（Osler's nodes）、詹納韋損害（Janeway lesions）、脾臟腫大
Cutaneous: Osler's nodes, Janeway lesions, splenomegaly.
而在感染性心內膜炎的臨床表徵中，出現羅氏斑並不是一個特異性的表現。雖然羅氏斑可能在感染性心內膜炎患者中出現，但並非其典型表現。
While Osler's nodes may be seen in patients with infective endocarditis, they are not specific to this diagnosis.
除了心內膜炎還有一種可能由於感染導致的心包填塞。
Apart from endocarditis, there is another type of cardiac tamponade that can be caused by infection.
心包填塞（cardiac tamponade）
可能由於病毒、細菌或結核性導致的心包炎、原發性或轉移性的腫瘤、外傷或手術、心肌梗塞導致心臟破裂、腎衰竭、甲狀腺低下、紅斑性狼瘡或藥物過敏導致，這是一種危及生命的急症，發生原因是心包腔（包圍心臟的雙層膜之間的空間）內積聚過多的液體，導致心臟受到壓迫，無法有效地充盈和收縮。
This is a life-threatening condition caused by the accumulation of fluid in the pericardial sac, compressing the heart and impairing its ability to pump effectively. Common causes include viral, bacterial, or tuberculous pericarditis; malignancy; trauma; surgery; myocardial rupture; renal failure; hypothyroidism; systemic lupus erythematosus; and drug reactions.
全身性紅斑性狼瘡（SLE） 是一種慢性自體免疫疾病，身體的免疫系統錯誤地攻擊自身組織，導致多器官發炎。由於SLE無法根治，治療的目標主要在於控制病情、減輕症狀，並預防器官損傷。
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease where the body's immune system mistakenly attacks its own tissues, leading to inflammation in multiple organs. Since there is no cure for SLE, treatment focuses on controlling the disease, relieving symptoms, and preventing organ damage.
類固醇藥物，例如潑尼松（prednisone），是治療SLE的重要藥物之一。類固醇能有效抑制免疫系統，減輕炎症反應，但長期使用可能導致骨質疏鬆等副作用。因此，在控制SLE的同時，也必須密切關注骨質疏鬆的風險，並採取預防措施，如補充鈣質和維生素D，或使用骨質疏鬆症治療藥物。
Corticosteroids, such as prednisone, are a cornerstone of SLE treatment. They effectively suppress the immune system and reduce inflammation, but long-term use can lead to side effects like osteoporosis. Therefore, while controlling SLE, it is crucial to monitor for osteoporosis and take preventive measures such as calcium and vitamin D supplementation or osteoporosis medications.
除了類固醇，免疫抑制劑也是治療SLE的常用藥物。這些藥物能抑制免疫系統的過度活化，進一步減輕炎症反應。
In addition to corticosteroids, immunosuppressants are also commonly used to treat SLE. These drugs suppress the overactive immune system, further reducing inflammation.
預防心包填塞是SLE治療的重要一環。心包填塞是SLE的嚴重併發症之一，若不及時治療可能危及生命。因此，患者應積極配合醫師的治療，定期服用藥物，並注意生活習慣，如避免感染、過度疲勞和日曬，以降低心包填塞的風險。
Preventing pericarditis is a critical aspect of SLE management. Pericarditis is a serious complication of SLE that can be life-threatening if left untreated. Therefore, patients should actively cooperate with their doctor's treatment, take medications regularly, and pay attention to lifestyle factors, such as avoiding infections, excessive fatigue, and sun exposure, to reduce the risk of pericarditis.
臨床表徵Clinical Manifestations
因心輸出量減少導致血壓下降，導致動脈性低血壓
Hypotension due to decreased cardiac output.
靜脈回流受阻，頸靜脈充盈，導致頸靜脈怒張
Jugular venous distension due to impaired venous return.
當心包腔積液增多時，心包層間的摩擦減少，心包膜摩擦音反而會減弱或消失，而不是增強。
Diminished or absent pericardial friction rub as the pericardial space fills with fluid.
心臟壓迫肺臟，導致呼吸困難。
Dyspnea due to cardiac compression of the lungs.
若有相關表徵，應進行心電圖、胸部X光、心臟超音波等，以確立診斷並進行相應的治療。
If these symptoms are present, an electrocardiogram, chest X-ray, and echocardiogram should be performed to confirm the diagnosis and initiate appropriate treatment.
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