Sun21November0735PM 8

An 85-year-old lady, previously fit and well, presented to the Emergency department with a four week history of fevers, rigors and malaise.

On arrival she was found to have a soft pansystolic murmur and a temperature of 39°C. She has had splinter haemorrhages (two on the left and four on the right) and bilateral palmar erythema. She had three sets of blood cultures taken which all cultured Streptococcus viridans.

A transthoracic echocardiogram demonstrated a mobile mass on the posterior mitral valve leaflet with moderate mitral regurgitation. She was promptly started on appropriate IV antibiotics.

Which of the following factors has the most impact on prognosis?

(Please select 1 option)

Presence of splinter haemorrhages

Streptococcus viridans in six blood cultures

Presence of moderate mitral regurgitation Incorrect answer selected

Old age This is the correct answer

Duration of symptoms

Explanation

Prognosis is strongly dependent on patient characteristics. The following are all poor prognostic factors:

Old age

Presence of prosthetic valve endocarditis

Insulin dependent diabetes mellitus, and

Severe comorbitities.

Other factors that are crucial in prognostic assessment are:

Endocarditis due to fungus or Gram negative bacilli

Endocarditis complications including heart failure, renal failure, stroke, septic shock and periannular complications, and

Echocardiographic findings including severe left sided valve regurgitation, low left ventricular ejection fraction, pulmonary hypertension, large vegetations and severe prosthetic valve dysfunction.

Reference:

Habib G, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009). Eur Heart J. 2009;30:2369-413.

Answer Statistics

1

5%

2

15%

3

31%

4

45%

5

7%

Times answered: 239