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Related Concept Videos

Rheumatic Heart Disease I: Introduction01:23

Rheumatic Heart Disease I: Introduction

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Rheumatic heart disease or RHD is a chronic condition that results from rheumatic fever, causing permanent damage to the heart valves.Etiology and Risk FactorsIt primarily arises from rheumatic fever, an inflammatory disease that can develop after untreated or inadequately treated group A streptococcal (GAS) pharyngitis. Streptococcus spreads through direct contact with oral or respiratory secretions. While the bacteria are the causative agents, factors like malnutrition, overcrowding, poor...
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Endocarditis II: Clinical Features of Infective Endocarditis01:25

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Endocarditis can present various clinical features depending on the causative organism and the patient's underlying health conditions. Initially, the clinical features of infective endocarditis develop gradually, presenting with nonspecific symptoms that can be easily mistaken for other illnesses.General SymptomsEarly symptoms of infective endocarditis are fever, chills, weakness, malaise, fatigue, and weight loss. These symptoms reflect the systemic nature of the infection and the body's...
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Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies01:22

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The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...
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Endocarditis I: Introduction01:25

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Introduction:Endocarditis is the infection of the endocardium, the inner lining of the heart and its valves. When the heart muscle is involved, the condition is termed myocarditis, while an infection of the outer lining is called pericarditis. Infective endocarditis (IE) primarily affects the endocardium, where pathogens adhere to the valves or lining, forming vegetation that can lead to severe complications. Infective endocarditis occurs when microorganisms, usually bacteria from other body...
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Endocarditis III: Medical Management01:18

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Infective endocarditis management involves a multifaceted approach encompassing infection prevention, lifestyle modifications, pharmacological therapy, and surgical management.Infection Prevention:Hand Hygiene: Thorough handwashing is crucial to prevent the spread of infection. Hand hygiene should be performed regularly, especially before and after using the restroom.Oral Hygiene: Good oral hygiene is essential. It includes brushing teeth immediately after waking up and before bed, flossing...
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Myocarditis II: Clinical Features and Diagnostic Tests01:27

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Myocarditis is an inflammation of the heart muscle. The symptoms vary widely, encompassing asymptomatic presentations to severe, acute manifestations.Clinical PresentationAsymptomatic cases: In some instances, myocarditis may be asymptomatic, with the infection resolving without intervention. These cases often go undetected unless discovered incidentally through diagnostic imaging or tests conducted for other reasons.General Early Symptoms: Early symptoms of myocarditis are non-specific and can...
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Infective Endocarditis Masquerading as Rheumatoid Arthritis.

Basil Peechakara1, Amey Kadam1, Megha Mewada1

  • 1Internal Medicine, Aastha Lifecare Hospital and Medical Centre, Mumbai, IND.

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Summary

Infective endocarditis can mimic autoimmune joint disease with high rheumatoid factor (RF) levels. Prompt diagnosis using echocardiography is crucial for better outcomes in suspected cases of this serious infection.

Keywords:
infective endocarditisrheumatoid factorstreptococcus gordonii

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Area of Science:

  • Cardiology
  • Rheumatology
  • Infectious Diseases

Background:

  • Infective endocarditis (IE) often presents with elevated inflammatory markers, including rheumatoid factor (RF).
  • Diagnosis can be challenging when IE mimics autoimmune joint diseases, particularly with musculoskeletal symptoms and high RF titers.
  • Ruling out IE through echocardiography and blood cultures is critical in such presentations.

Observation:

  • A 42-year-old male with diabetes mellitus presented with prolonged back pain, hemoptysis, joint pain, and fever.
  • Initial diagnosis by a rheumatologist was rheumatoid arthritis, with an RF level of 505.3 IU/mL.
  • Transthoracic echocardiography (TTE) revealed vegetations on the aortic valve, later confirmed by transesophageal echocardiography (TEE), which also showed mitral valve leaflet perforation and regurgitation.

Findings:

  • High RF levels can be associated with IE, potentially due to the intense immune response to chronic intravascular infection.
  • Echocardiography is essential for diagnosing IE when clinical presentation is ambiguous.
  • The patient was successfully treated with a course of ceftriaxone and gentamicin.

Implications:

  • This case highlights the importance of considering and ruling out IE in patients with unexplained inflammatory markers and musculoskeletal symptoms.
  • Prompt echocardiographic evaluation can lead to earlier diagnosis and intervention, improving patient outcomes.
  • High RF titers should not preclude the investigation for infective endocarditis in the appropriate clinical context.