Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a history of recurrent streptococcal pharyngitis, now reporting progressive dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea. Associated symptoms include palpitations, chest discomfort, and peripheral edema. No history of recent fever or migratory polyarthritis.
Clinical Examination Findings
Cardiovascular exam reveals a hyperdynamic precordium with a displaced apical impulse. Auscultation demonstrates a diastolic rumble at the apex (mitral stenosis) and/or a holosystolic murmur at the apex radiating to the axilla (mitral regurgitation). S1 is accentuated; S2 is split. No signs of acute heart failure or peripheral stigmata of infective endocarditis.
Treatment Protocol
Initiate secondary prophylaxis with intramuscular Benzathine Penicillin G every 3-4 weeks. Manage heart failure symptoms with diuretics (e.g., Furosemide) and ACE inhibitors/ARBs. Rate control for atrial fibrillation with Beta-blockers or Digoxin. Consider surgical consultation for valve repair or replacement if hemodynamically significant valvular dysfunction persists.