A 35 year-old man is admitted with a one-week history of cough, shortness of breath and fever. He has no known prior illness or cardiovascular risk factors but is known to have a longstanding heart murmur, which was not previously investigated. There is no evidence of previous intravenous drug abuse. He continues to experience episodes of diaphoresis and fever. Cardiac exam reveals an added ejection systolic and an early long diastolic murmur. His C-Reactive protein peaks at 254 mg/L and 2 sets of blood cultures are positive for Streptococcus Parasanguis.
Have a look at the transthoracic echocardiogram images in the classroom.
Questions for discussion:
- What is the diagnosis and what are the findings from the echocardiogram?
- How would you manage the condition?
- What are the complications of this condition?
Students, add your ideas to the class discussion board. Many thanks to Dr Nikhil Joshi and Dr Anoop Shah for this week’s case.
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This case led to a very interesting discussion in the classroom. The diagnosis was infective endocarditis. We discussed the many complications of infective endocarditis and how it should be managed. In this case, the complication was an aorto-atrial fistula, which is quite rare. We considered some very interesting images, and honed our echocardiogram interpretation skills