An 80-year-old woman is referred to your cardiac practice with no fever but worsening exertional fatigue. She has had a heart murmur since she was young. It appears to have worsened recently. At her 80th birthday party 4 weeks ago, two of her great nieces were sick, and she thinks she picked up their sore throat. She was sick with fever for about a week 3 weeks ago but did not have enough energy to go to the doctor. If you did standard bacterial blood cultures, what would be the most likely outcome?

Question

Quizplus · Accepted Answer

Without dental work or gastrointestinal or genitourinary manipulation and with the pharyngitis, the most likely explanation is that your patient had rheumatic heart disease made worse recently by an untreated strep throat. Because it is the antibodies (and, perhaps, immune cells) circulating and interacting with the heart and not bacteria, the blood cultures should be sterile. Antistreptolysin O titer should be positive.

An 80-Year-Old Woman Is Referred to Your Cardiac Practice with No