UMEM Educational Pearls

Title: Visual Diagnosis

Keywords: echocardiography, rheumatic heart disease, endocarditis, international (PubMed Search)

Posted: 3/19/2014 by Andrea Tenner, MD
Click here to contact Andrea Tenner, MD

Question

35yo M with history of rheumatic heart disease presents with fever. What disease process is suggested by the echo?

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.

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