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Journal of Echocardiography

, Volume 13, Issue 3, pp 121–122 | Cite as

A revealing murmur

  • Patrícia RodriguesEmail author
  • Sofia Cabral
  • Mário Santos
  • Maria João Sousa
  • Bruno Brochado
  • Paulo Palma
  • Severo Torres
Case image in cardiovascular ultrasound
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A 64-year-old female patient with chronic kidney failure on dialysis complained of fatigue, productive cough, and mild fever for 1 month.

On physical examination, the remarkable findings were hypotension, tachycardia, bilateral basal crackles, and mild bipedal edema. She also had a mild systolic murmur. She had a mildly elevated white blood count (13 × 109/l) and high C-reactive protein (194 mg/l). A chest X-ray showed a discrete opacification in the right lower lobe and an electrocardiogram revealed sinus tachycardia and non-specific repolarization abnormalities. A bedside echocardiogram showed mild aortic stenosis and preserved biventricular systolic function.

The presumption of sepsis with a probable pulmonary origin led to her admission and she was started on broad-spectrum antibiotics; the cultures came back negative.

However, the in-hospital clinical course was unfavorable, evolving to septic shock after 3 weeks. A significant increase in intensity of the systolic murmur was...

Keywords

Endocarditis Right Ventricle Right Atrium Systolic Murmur Chronic Kidney Failure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflict of interest

Authors Patrícia Rodrigues, Sofia Cabral, Mário Santos, Maria João Sousa, Bruno Brochado, Paulo Palma and Severo Torres declare that they have no conflict of interest.

Human rights statements and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later revisions. Informed consent was obtained from all patients for being included in the study.

References

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    Gerbode F, Hultgren H, Melrose D, et al. Syndrome of left ventricular-right atrial shunt: successful surgical repair of defect in five cases, with observation of bradycardia on closure. Ann Surg. 1958;148:433–46.PubMedCentralCrossRefPubMedGoogle Scholar
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    Habib G, Hoen B, Tornos P, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the task force on the prevention, diagnosis, and treatment of infective endocarditis of the European Society of Cardiology (ESC). Eur Heart J. 2009;30:2369–413.CrossRefPubMedGoogle Scholar
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    Doulton T, Sabharwal N, Cairns HS, et al. Infective endocarditis in dialysis patients: new challenges and old. Kidney Int. 2003;64:720–7.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Echocardiography 2015

Authors and Affiliations

  • Patrícia Rodrigues
    • 1
    Email author
  • Sofia Cabral
    • 1
  • Mário Santos
    • 1
  • Maria João Sousa
    • 1
  • Bruno Brochado
    • 1
  • Paulo Palma
    • 1
  • Severo Torres
    • 1
  1. 1.Cardiology Department, Centro Hospitalar do Porto, Serviço de CardiologiaHospital de Santo AntónioPortoPortugal

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