Answer: Mitral valve vegetation/Endocarditis

 

Any prior defects to cardiac valves increases your risk of endocarditis.  Rheumatic heart disease classically causes damage to either the mitral or aortic valve.   Of these patients, around 60%  will have mitral stenosis  and 20% will have pure mitral insufficiency.  The bacteria most commonly involved is Group A hemolytic strep.  Recommended antibiotics include penicillin and ceftriaxone.  

 

In a patient with known cardiac valvular disease, including rheumatic heart disease, keep endocarditis in your differential!

 

Univeristy of Maryland Section for Global Emergency Health

Authors: Colleen Holley and Van Pham