A 23-year-old patient presents the emergency department with high fever, chills, extreme fatigue, and arthralgias. Your physical examination reveals grade II heart murmur heard loudest over the fourth intercostal space left sternal border
The arms of the patient reveal past intravenous drug abuse. The clinician should recognize these are signs and symptoms of:
A. Pulmonary embolism
B. Right ventricular failure
C. Functional heart murmur
D. Bacterial endocarditis
ANS: D
Bacterial endocarditis is a microbial infection of the endocardium. The most common causative organisms are Staphylococcus aureus, group A streptococcus, pneumococcus, and gonococcus. Risk factors include valvular disease, intravenous drug use, dental disease, and invasive diagnostic procedures. Initially, the signs and symptoms are similar to those of other systemic illnesses, including fever, chills, arthralgias, malaise, and fatigue. Petechiae, anemia, weight loss, new or worsening heart murmur, and emboli alert the examiner to a more serious disease process.
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