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Dr Jonathan Henry

FACEM, GDipClinUS (University of Melbourne), CCPU (ASUM)

Twitter: @DrJonoHenry @EmergencyEcho

Post Peer-Reviewed by Dr Gillian Whalley, Professor of Clinical Sonography/Cardiology, University of Otago, New Zealand

Twitter: @GWhalleyPhD

Bedside echo demonstrated anterior and posterior mitral valve leaflets (AMVL/PMVL), thickened by heavy vegetations. His PMVL was prolapsing, with severe mitral regurgitation (MR) causing acute pulmonary oedema.

He was urgently transferred to a cardiothoracic unit and stabilised. His comprehensive echo showed severe MR and moderate-sized mitral vegetations with a possible impact lesion. He eventually underwent mitral valve replacement and thankfully on discharge months later had minimal residual neurological deficit.

2. A male in his 40s presented septic, drowsy, with vague complaints of pain in his R flank and down his R thigh. Examination did not reveal any septic focus relevant to the location of the pain, his urine was clear, and he had no septic focus in his abdominal, vertebrae or soft tissues. He did however have an obvious diastolic murmur, and it was unknown whether this was acute or chronic.

Bedside echo showed severe aortic regurgitation (AR). The LV was not yet significantly dilated, suggesting that the AR was acute. My imaging was sub-optimal, and I did not identify an obvious aortic valve (AV) vegetation - his scan was ‘indeterminate’.

I admitted the patient with heightened suspicion for IE as the primary septic focus. His comprehensive echocardiogram the following day confirmed an AV non-coronary cusp vegetation with acute severe AR.

3.  Another male in his 40s presented with a week of fever and heart failure symptoms - orthopnoea and dyspnoea on exertion. He had no known IE risk factors. He was overweight, however otherwise looked reasonably well from the end of the bed. On examination he had bilateral lung crackles, mild peripheral oedema, and a new murmur.


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