A revealing murmur
- 70 Downloads
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...
KeywordsEndocarditis Right Ventricle Right Atrium Systolic Murmur Chronic Kidney Failure
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.
- 2.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