Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a history of persistent fever, chills, and night sweats. Reports recent onset of fatigue, dyspnea on exertion, and orthopnea. No history of IV drug use, recent dental procedures, or indwelling catheters. Cardiac history significant for known mitral valve prolapse/regurgitation. Symptoms are progressive over [Number] weeks.
Clinical Examination Findings
Vitals: Febrile (T: [Temp]), Tachycardic (HR: [Rate]). HEENT: Conjunctival petechiae noted. Cardiovascular: Holosystolic murmur grade [Grade]/6 heard best at the cardiac apex, radiating to the axilla. No gallops or rubs. Extremities: Osler nodes on digits, Janeway lesions on palms/soles, and splinter hemorrhages noted on nail beds. No peripheral edema.
Treatment Protocol
Initiate empiric IV antibiotic therapy (e.g., Vancomycin + Ceftriaxone) pending blood culture sensitivity results. Serial echocardiography (TTE/TEE) to monitor vegetation size and valve function. Consult Cardiothoracic Surgery for evaluation of mitral valve repair/replacement if complications (e.g., severe regurgitation, heart failure, embolic events) arise. Monitor renal function and inflammatory markers (ESR/CRP).