Peter is a 62-year-old accountant who presented after two and a half weeks of an

ongoing flu-like illness. He reported headaches, arthralgia and general malaise

initially, but over the most recent week, he had been experiencing frequent episodes
of palpitations night sweats and overwhelming fatigue. There was no history of
travel or insect bites or extramarital sexual activity. He reported that he had a long-
term heart murmur that had followed an attack of rheumatic fever as an adolescent.
Physical examination: BP 130/90 , CR 112 irregular, RR 22/ min T 38.9 (+) loud
systolic ejection murmur in the aortic area.
Blood tests were not helpful, with the only abnormality reported being elevated levels
of C-reactive protein (CRP; 70mg/L) and erythrocyte sedimentation rate.
1. Identify the different medical problems (present and potential) of this patient
Present: Rheumatic heart disease
Potential: Infective endocarditis, Mitral stenosis, Mitral valve prolapse, Aortic
stenosis, Aortic regurgitation, Tricuspid stenosis
2. Establish the pathophysiology
3. Any other diagnostic test that you like to add? Whats the significance and expected
findings if present in the case.
4. What would be the medical management? Surgical?
5. Create your NCPs. State the problems according to priority.