# data[].attributes.body
LO1 Apply the knowledge of surface anatomy to interpret chest physical examination findings
a. why JVP is raised? 🌲
b. how splenomegaly occur? (relate with chronic infection) 🌲
c. types and characteristics of murmur + grading 🌴

LO2 Relate the pathogenesis and pathophysiology of infective endocarditis to its clinical
presentations
d. Definition + Classification + Infective causes (type of microorganism) 🎋
e. Pathogenesis of IE 🎋
f. pathophysio of fever & breathlessness 🥗
g. pathophysio splinter hemorrhage 🥗
h. relation between bp / pulse rate / respi rate / body temp.
+ why rheumatic fever tend to affect mitral valve rather than others?
+ why does ineffective endocarditis like to stay at mitral valve ? 🏡🏡

LO3 Outline the principles of management of infective endocarditis
i. Investigation (lab + imaging) 🔰
j. Diagnosis criteria (major n minor) 📗
k. Prognosis 📗
l. Management (antibiotics) 🍀

LO4 Discuss the psychosocial implications of infective endocarditis
m. Psychosocial impact (MERCI) 🍀

# data[].attributes.body
- why rheumatic fever tend to affect mitral valve rather than others?
- why inefective endocarditis like to stay at mitral valve ?
-Type and characteristic of murmur
- inefective endocarditis :  definition , classification, investigation(imaging), management(antibiotic), diagnostic criteria (major &minor) ,causes ,type of microorganism,prognosis , merci
- pathophysiology of spinter hemorrhage

# data[].attributes.body
JVP
- Pathophysiology of elevated JVP  (chronology how it happens)
- overview of how cardiac backflow occur
- cause by increase right atrium pressure

# data[].attributes.body
Apex beat
- displaced
- indicates cardiomegaly

# data[].attributes.body
splinter hemorrhages
- explain about the pathophysiology
- no pain
- if caused by trauma = feel pain

# data[].attributes.body
poor dental hygiene
- low income family - do not care about the oral hygiene
- cause of infection from oral cavity
- more bacteria , more prone to get infection

# data[].attributes.body
BP = normal
Pulse rate = high
respi rate = normal
body temperature = high
jvp = elevated
apex beat = displaced
S1 = soft
high pitched murmur ?

# data[].attributes.body
General examination revealed poor dental hygiene and presence of splinter haemorrhages.

His blood pressure was 120/70 mmHg, pulse rate was 110 beats/min with regular rhythm, respiratory rate was 18 breaths/min, and body temperature was 38.9 ºC. The jugular venous pressure was at 5 cm. The apex beat was at the 6th left intercostal space lateral to the midclavicular line and forceful in nature.
On auscultation, the first heart sound was soft. There was a high-pitched, grade 3/6 pansystolic murmur at the mitral area. It was rumbling in nature and radiated to the left axilla. There were fine basal crepitations in both lungs. The liver was not enlarged. The spleen was palpable 1 cm below the left costal margin. A provisional diagnosis of infective endocarditis (IE) was made. Empirical intravenous antibiotics were started.

# data[].attributes.body
5. rheumatic fever
- once diagnosed : antibiotics
- reason to follow up the patient :
* duration of antibiotic longer
* cardiovascular complication - valvular  heart disease
- fever happen due to tooth extraction or reoccurrence of rheumatic fever?
*
- cannot rely on history taking only & need to do physical examination & investigation

# data[].attributes.body
4. tooth extraction
- removal of the teeth
- infection
- oral hygiene
- possible of having fever due to pain
- systemic infection cause fever
- oral cavity is port for microorganism to be alive (contamination from food)

# data[].attributes.body
3. breathlessness
- frequency of occurrence
- nature of sleeping
- onset
- possible of respiratory infection
- term for breathlessness in CVS
* paroxysmal nocturnal dyspnea
* orthopnea
- elaborate in history of breathlessness
*associated symptoms
*medication to relief
* asthma?
* acute exacerbation?

# data[].attributes.body
2. two weeks history of fever and breathlessness
- chief complaint
- abnormal fever
- prolonged fever :
- pyrexia unknown origin : described as a persistent fever above 38.3°C (100°F) that evades diagnosis for at least 3 weeks, including 1 week of investigation in hospital.
- etiology of prolonged fever

# data[].attributes.body
1. 18 years male
- student
- early adulthood
- right after SPM
- do not need parent consent (but need some advice from parents )
- part time job

# data[].attributes.body
Wong, an 18-year-old male, complained of two weeks history of fever and breathlessness. He had tooth extraction prior to the onset of fever. He had acute rheumatic fever at 10 years of age. He had however defaulted treatment.