1. Echo-Conference R2 조경민

2. History 12025086 박 O 화 (F/31) Chief Complaint Chief Complaint Fever.chilling & Chest discomfort O/S) 10 days ago Fever.chilling & Chest discomfort O/S) 10 days ago Present illness A 31 year old woman had taken medication for fever,nausea,chest discomfort at local hospital. But her symptom kept continuously.so was admitted to KMC medicine for further evaluation

3. Past Medical History HTN (-) / DM(-) / Hepatitis(-) / Pulmonary TB(-) HTN (-) / DM(-) / Hepatitis(-) / Pulmonary TB(-) Operation Hx. (-) Operation Hx. (-) Personal History Alcohol (-) Alcohol (-) Smoking (-) Smoking (-) Family History Unremarkable Unremarkable History

4. Review of System General Fatigue(+) Febrile sensation(+) Chill(+) Wt. gain (-) Skin Rash(-) Pigmentation(-) Itching(-) H&N Headache(-) Sore throat(-) Dysarthria (-) Respiratory Cough(-) Sputum(-) Hemoptysis(-) Cardiac Chest discomfort(+) Orthopnea(-) Dyspnea(-) Edema(-) Exercise limits (-) Palpitation(-) Exercise limits (-) Palpitation(-) G-I Postprandial abd. discomfort (-) Anorexia(-) Nausea(-) Vomiting(-) Abd. pain(-) Vomiting(-) Abd. pain(-) Renal Dysuria(-) Urgency(-) Frequency (-) Hematuria(-) Muscularskeletal Pain(-) Weakness(-) Nervous System Motor problem (-)

5. Physical Examination V/S 100/60mmHg – 88/min – 20/min – 38.3°C V/S 100/60mmHg – 88/min – 20/min – 38.3°C General Appearance General Appearance Alert mental status Alert mental status Chronic ill-looking appearance Chronic ill-looking appearance Head & Neck Head & Neck No cervical LN enlargement No cervical LN enlargement No neck vein engorgement No neck vein engorgement No thyroid enlargement No thyroid enlargement Eye & ENT Eye & ENT Isocoric pupil with PLR(++/++) Isocoric pupil with PLR(++/++) Pinkish conjunctiva with Clear sclera Pinkish conjunctiva with Clear sclera Body weight :46.3 Kg Height : 161.4 cm BMI:17.8kg/m 2

6. Physical Examination Chest Chest Clear breathing sound without crackle or wheezing Clear breathing sound without crackle or wheezing Regular heart beat with systolic murmur Regular heart beat with systolic murmur Abdomen Abdomen Soft & flat abdomen Normoactive bowel sound Soft & flat abdomen Normoactive bowel sound Tenderness(-) Rebound tenderness(-) Tenderness(-) Rebound tenderness(-) Back & Ext. Back & Ext. CVA tenderness (-/-) Pretibial pitting edema(-/-) CVA tenderness (-/-) Pretibial pitting edema(-/-) Neurologic examination Neurologic examination Babinski (-/-) Ankle clonus (-/-) Babinski (-/-) Ankle clonus (-/-) Late systolic murmur Mid systolic click

7. Initial Lab. Findings CBC/DC CBC/DC 3700/mm 3 –12.1g/dL – 35.1 % -171000 /mm 3 3700/mm 3 –12.1g/dL – 35.1 % -171000 /mm 3 (Seg. 59.8%) (Seg. 59.8%) Chemistry Chemistry Total Bilirubin 0.46mg/dL Total Bilirubin 0.46mg/dL Prot/ Alb 7.5 / 4.5 g/dL Prot/ Alb 7.5 / 4.5 g/dL AST/ALT 15/ 11 U/L AST/ALT 15/ 11 U/L ALP/ GTT 32/ 12 U/L ALP/ GTT 32/ 12 U/L BUN/ Cr 10/ 0.7 mg/dL BUN/ Cr 10/ 0.7 mg/dL Na/K/Cl 145/4.4/103 mg/dL Na/K/Cl 145/4.4/103 mg/dL Ca/ P /Uric acid 8.2/ 4.1/3.9mg/dL Ca/ P /Uric acid 8.2/ 4.1/3.9mg/dL

8. Chest X-ray (2009.01.29)

9. EKG (2009.01.29)

10. Initial Assessments #1. FUO #1. FUO R/O infective endocarditis R/O infective endocarditisr/o

11. Echocardiography (2009.01.29) Echocardiography 시행 이유 Echocardiography 시행 이유 : Infective endocarditis 의 해부학적인 확인 : Infective endocarditis 의 해부학적인 확인 Vegetation 의 크기 결정, 심방내 합병증 발견 및 심장 기능의 평가 Vegetation 의 크기 결정, 심방내 합병증 발견 및 심장 기능의 평가 Transthoracic echocardiography Transthoracic echocardiography

12. Final diagnosis #1. Mitral valve Prolapse #1. Mitral valve Prolapse #2. FUO #2. FUO