Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a history of rheumatic fever, now reporting progressive exertional dyspnea, orthopnea, and palpitations. Denies syncope or angina. Symptoms are consistent with chronic aortic regurgitation secondary to rheumatic valvular disease. Functional status: NYHA Class [I/II/III/IV].
Clinical Examination Findings
Cardiovascular exam: Hyperdynamic precordium, displaced apical impulse. Auscultation reveals a high-pitched, blowing, decrescendo diastolic murmur heard best at the left sternal border (Erbโs point). Presence of wide pulse pressure and peripheral signs of AR (e.g., Corriganโs pulse, de Mussetโs sign). No signs of acute heart failure.
Treatment Protocol
Initiate ACE inhibitor/ARB for afterload reduction. Beta-blockers indicated if tolerated. Strict adherence to secondary prophylaxis with Penicillin G benzathine as per guidelines. Monitor via serial echocardiography to assess LV dimensions and ejection fraction. Surgical consultation for valve replacement/repair if symptomatic or if LV dysfunction develops.