Last updated on 24 Jul 2014 at 9:54 AM (ID04)

Fever and a new murmur
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