Rheumatic Heart Disease Short Case Presentation Seen with Dr John Stirling - Cardiology Rosella is a 12 year old girl

who appears thin for her age and I would like to plot her height and weight on age appropriate centile chart. She is in bed comfortable at rest and not on any oxygen. She does not have any IV infusions running at the moment. On inspection of her hand there is no clubbing, no splinter haemorrhages and no embolic phenomenon noted and she has a regular pulse rate of 80 bpm. She has a collapsing pulse. There is no radial-radial delay. I was given a BP by the examiner which shows a widened pulse pressure (difference is >50mmHg between diastolic and systolic BP). She had a resp rate of 28 which is increased for her age. She had no pallor or jaundice in the sclera. Dentition was good with no central cyanosis. I moved on to examine the chest there were no scars from previous surgery noted. She had some ECG dots on her chest wall anteriorly. Her apex beat is displaced to 6 th intercostal space mid axillary line and is a prominent thrusting apex beat. There are no other heaves or thrills. She has a loud pan systolic murmur 3/6 at the apex radiating to axilla. There is a diastolic murmur 2/4 heard at left sternal border. Chest is resonant to percussion with few crackles heard bibasally and there is no oedema. There is no obvious joint effusion or swelling noted.

These findings are consistent with mitral regurgitation and aortic regurgitation which in this patient are most likely due to Rheumatic Heart Disease that could be either acute or chronic she has some features of cardiac failure. My differential is Infective endocarditis although this is less likely than Rheumatic Heart disease. To further investigate this I would like to do blood tests looking at FBC for infective process, inflammatory markers and monitoring trend in ESR and CRP, throat swab and strep titres. I would like to see recent chest x-ray and ECG. Further investigation to confirm would be an ECHOCARDIOGRAM.