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Fever and a new murmur

Clinical Discipline(s)/Organ System(s)
Cardiology, Cardiovascular System, Infectious Diseases, Microbiology
Progress Test Topic(s)
Cardiovascular, Infectious disease
Description
A 39 year old Samoan/Niuean man presents with a fever and lethargy for the past 2 weeks. On examination he has a fever, splinter haemorrhages and an early diastolic murmur.
Applied Science for Medicine 
   - Anatomy of the heart and cardiovascular system
   - Physiology of the cardiac cycle and murmur generation
   - Pathogenesis of rheumatic fever
   - Common causes and pathology of bacterial endocarditis
   - Pharmacology of penicillins, cephalosporins and vancomycin
Clinical and Communication Skills 
   - History from a patient with fever
   - History from a patient with a murmur and risk factors for endocarditis
   - Perform an examination of a patient with a fever
   - Examine the cardiovascular system and recognise the peripheral signs of endocarditis
   - Diagnostic criteria for endocarditis (Duke criteria)
   - Interpret blood cultures, midstream urine, ECG, echocardiogram
   - Suggest appropriate antibiotic regimens for endocarditis; dual therapy
   - Role of surgery in the management of endocarditis
   - Complications of endocarditis
   - Situations where prophylactic antibiotics are required to prevent endocarditis
   - Discuss the long-term impacts: e.g. warfarin post-valve replacement
Personal and Professional Skills 
   - Discuss the need for the patient to continue long-term therapy, even when clinically improved and impact this will have on daily living (including work, sport)
Hauora Māori 
   - Ability to cater for differential health literacy needs of Māori patients and whānau
   - Awareness of differing risk profiles for Māori (and other disadvantaged populations) compared with non-Māori in New Zealand presenting with heart murmurs
   - Understanding of inequities in rheumatic heart disease outcomes for Māori compared with non-Māori, and application of this to clinical decision making and management
   - Understanding of the role of kaupapa Māori health policies, services and research in reducing rheumatic heart disease inequalities
Population Health 
   - Epidemiology of rheumatic fever
   - Screening for rheumatic fever (and sequalae)
   - Primary and secondary prevention of rheumatic fever
   - Sequelae of rheumatic fever and screening and/or treatment options
   - Screening for congenital heart defects
   - Endocarditis prophylaxis
Conditions to be considered relating to this scenario
Common
bacterial endocarditis (Staphylococcus aureus, Viridans streptococci, Enterococcus faecalis), rheumatic fever, flow murmur
Less common but 'important not to miss'
Haemophilus/Actinobacillus/Cardiobacterium/Eikenella/Kingella (HACEK), pericarditis, myocarditis, severe sepsis/septicaemia
Uncommon
congenital heart disease, non-bacterial endocarditis, atrial myxoma
Related Scenarios
[Valvular heart disease]