Question

For the Disease Summary for this case study, see the CD-ROM PATIENT CASE HPI Mr. H.Y. is a 63-year-old male, who presents to the ER with a two-day history of high-grade fever with chills. "I don't feel well and I think that I may have the flu," he tells the ER nurse and physician. He also complains of "some painful bumps on my fingers and toes that came on last night." He denies IVDA. When asked about recent medical or dental proce- dures, he responded: "I had an infected tooth removed about two weeks ago." He does not recall receiving any antibiotics either prior to or after the procedure. Patient Case Question 1. Which type of infective endocarditis is suggested by the patient's clinical manifestations-acute or subacute? PMH Asthma since childhood Rheumatic fever as a child x 2 with mitral valve replacement 2 years ago HTN X 20 years DM type 2, x 9 years COPD X 4 years H/O tobacco abuse Alcoholic liver disease Patient Case Question 2. Which three of the illnesses in this patient's medical history may be contributing to the onset of infective endocarditis and why are these diseases considered risk factors?

10 questions

Answer 1

1Q).

Endocarditis is generally caused by the normal microbiota residing in the skin or mouth of the individuals, and is also observed in the people with rheumatic fever. Endocarditis increase the risk of stroke.

Subacute bacterial endocarditis (SBE) is a bacterial infection of the inner lining of the heart and the heart valves, which develop over a period of weeks or months. In contrast, the acute endocarditis begins suddenly and become fatal within a few days.

In the given case, the patient developed the symptoms two weeks after the teeth extraction, and did not use antibiotics before or after tooth extraction. Means, the infection might have initiated several weeks before. Thus, the patient had SBE.

2Q).

The risk factors of endocarditis in the given patient are,

1. Rheumatic fever as a child
2. History of tobacco abuse
3. Mitral valve replacement two years ago

Rheumatic fever is a bacterial infection caused by Streptococcal species. It generally causes inflammation of joints, heart diseases and also disturbs the nervous system. In 40% of the patients with rheumatic fever carditis (inflammation of heart) is observed. Inflammation of endocardium (inner layer of heart) causes the valve impairment particularly the mitral valve (left atrio-ventricular (AV) valve).

Tobacco abuse increase the risk of oral infections, which increase the risk of endocarditis. People with mitral valve replacement are also at higher risk of endocarditis.

3Q).

The symptoms including cough, chest pain, and breathing problems indicate severe tricuspid valve endocarditis, and pulmonary embolism. The absence of rashes and visual problems indicate the absence of embolus formation. So, absence of these symptoms indicate the absence of embolus formation.

4Q).

The past medical history (PMH) of the patient is given below:

• Asthma since childhood
• Rheumatic fever and mitral valve replacement
• Hypertension sine 20 years
• Type 2 diabetes mellitus
• Chronic obstructive pulmonary disease (COPD)
• History of tobacco abuse
• Alcoholic liver disease

Drugs used to expand the bronchial tubes are known as “bronchodilators.” They act by relaxation of bronchial smooth muscle. Theophylline is a bronchodilator that is used in the treatment of asthma and COPD for its smooth muscle relaxation property.