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Bicuspid aortic valve
5%
12/250
Aortic stenosis
2%
4/250
Mitral stenosis
6/250
Mitral valve prolapse
59%
147/250
Rheumatic heart disease
31%
78/250
Select Answer to see Preferred Response
The clinical presentation is consistent with native valve bacterial endocarditis (NVBE). The most common cardiac abnormality predisposing to NVBE in 15- to 60-year olds is mitral valve prolapse (MVP). NVBE is characterized by systemic symptoms such as high grade fevers, night sweats, fatigue and weakness. Embolization of cardiac vegetations may lead to specific dermatologic findings including Janeway lesions and Osler's nodes. Evaluation of NVBE requires blood cultures and echocardiography. MVP is usually an isolated abnormality, but can also be associated with connective tissue disorders such as Marfan syndrome. Patients with MVP are at higher risk for infective endocarditis (IE) of the mitral valve. In fact, MVP is the most common predisposing condition in 15- to 60-year-olds. Figure A shows Janeway lesions which are dark, non-tender macules on the palms and soles. Incorrect Answers: Answer 1, 2, 3: These cardiac conditions do not directly increase the risk of IE. Answer 5: Although rheumatic heart disease is associated with IE, mitral valve prolapse is the most common cardiac condition that predisposes patients to NVBE.
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