History of low- grade fever and shortness of breath

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A 55-year-old woman comes to the physician because of a 2-day history of low- grade fever and shortness of breath. She underwent a medical procedure, 4 days ago. She has a history of congenital heart disease and was hospitalized 2 months ago for respiratory infection. Her temperature is 37.80C (100oF), pulse is 65/min, respirations are 20/min and blood pressure is 115/70 mmHg. Physical examination shows splinter hemorrhages on the fingernails and a new 3/6 holosystolic murmur, loudest at the mitral area. Transthoracic echocardiography shows a small vegetation on her mitral valve. Laboratory studies indicate elevated WBC's (12,000 cells/mL) and ESR. Two

Reference no: EM133585243

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