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Question
35yo M with history of rheumatic heart disease presents with fever. What disease process is suggested by the echo?
.JPG)
Answer
Answer: Mitral valve vegetation/Endocarditis
Any prior defects to cardiac valves increases your risk of endocarditis. Rheumatic heart disease classically causes damage to either the mitral or aortic valve. Of these patients, around 60% will have mitral stenosis and 20% will have pure mitral insufficiency. The bacteria most commonly involved is Group A hemolytic strep. Recommended antibiotics include penicillin and ceftriaxone.
In a patient with known cardiac valvular disease, including rheumatic heart disease, keep endocarditis in your differential!
Univeristy of Maryland Section for Global Emergency Health
Authors: Colleen Holley and Van Pham
References
Burke AP. Pathology of rheumatic heart disease. Medscape. 2013. Accessed 19 Mar 2013 at http://emedicine.medscape.com/article/1962779-overview#aw2aab6b4.