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 prior valvular surgery. Denies chest pain or palpitations. Symptoms are consistent with subacute bacterial endocarditis involving the mitral valve.
Clinical Examination Findings
Vitals: Febrile (T: 38.5°C), Tachycardic (HR: 105 bpm). Cardiovascular: Grade III/VI holosystolic murmur heard best at the apex, radiating to the axilla. No signs of peripheral emboli (Osler nodes, Janeway lesions, or splinter hemorrhages). Lungs: Bilateral bibasilar crackles noted. Extremities: 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 mitral valve function. Consult Infectious Disease and Cardiothoracic Surgery for potential surgical intervention if hemodynamic instability or embolic events occur.