تصفح
دخول
تسجيل
نسيتها؟

woman with fever and history of valve replacment


woman with fever and history of valve replacment


حالة سريرية

الوصف الكامل Background
A 54-year-old woman with a history of valve replacement visits her dentist for a routine cleaning. Two days later, she develops a severe fever, has small hemorrhages on her fingers, and funduscopic evaluation reveals the presence of retinal hemorrhages. She becomes hypotensive and is rushed to the emergency department. Which of the following is the most diagnosis?
كتابة حرة وطرح موضوع النقاش!

(

A) Acute bacterial endocarditis
(B) Acute rheumatic fever
(C) Libman-Sacks endocarditis
(D) Nonbacterial thrombotic endocarditis
(E) Subacute bacterial endocarditis

المرجع

.

dr.tabban's picture
by

i'll write the answer coz i am leaving for some time.

a, the right answer, Previously damaged heart valves or prosthetic valves are susceptible to infection. Bacteria seed the valves in this case after dental work. The rapid decline of the patient and the peripheral and retinal hemorrhages reveal the likely diagnosis as acute bacterial endocarditis. In mechanical valves, if there is infection around the valve, it can lead to its possible dislodgement.

Acute rheumatic fever may lead to fever. If the myocardium is affected, conduction abnormalities may result. Repeated bouts affecting the myocardium lead to its scarring.

Libman-Sacks endocarditis presents as sterile vegetations on both sides of the heart valves. Fever and peripheral hemorrhage are not seen. These vegetations are seen in systemic lupus erythematosus.

As the name implies, nonbacterial thrombotic endocarditis is characterized by accumulation of small thrombotic emboli on the heart valves. This condition is associated with chronic diseases such as cancers.

While a normal heart valve is not usually susceptible to the less virulent organisms that give rise to subacute bacterial endocarditis, those with a prosthesis are. The important distinction is rapidity of the onset of symptoms.

dr.tabban's picture
dr.tabban


انا شخصيا فتت بالحيط
لانو عادة peopel with daaged valves develop SBE after dental work
but the history described consists more with an acute case
still i will go for acute
answer is A

Dr_Ayyad
بعد التخرج


مادام هناك تغيير صمام فأنت أمام احتمالين : Staph or Candida

Hot sauce's picture
Hot sauce
طبيب مقيم

(D) Nonbacterial thrombotic endocarditis

1- لا يوجد علامات إصابة خمجية.
2- تبديل صمامات.

KMG's picture
KMG
طبيب مقيم
ابق على تواصل مع حكيم!
Google+