Summary:

This patient was aware of a systolic murmur. Blood cultures were positive for Strep viridans. An echocardiogram confirmed the presence of mitral regurgitation and showed vegetations on the mitral leaflets.

Click to review auscultation.

Lessons:

1. The location, quality, and loudness of this murmur were important in considering mitral regurgitation as the cause.
2. Transesophageal echocardiography is often the best way to evaluate the possibility of valvular vegetations.In this case this was not necessary because the trans-thoracic echo had demonstrated vegetations. These abnormalities will disappear with antibiotic therapy.
3. Once the infection is cured, he should be able to resume full activity but he should be advised to have routine follow up evaluations every two years.

 

Case 8 is now finished.