Murmur on top of the head: bioprosthetic mitral valve insufficiency

In 1961, K Merendino ‘in pure curiosity’, while tracking the murmur of mitral regurgitation, placed his stethoscope ‘on the vertex of the head’, and ultimately led to a medical curiosity and exam finding that not only bears his name, but awes medical learners at all stages of their careers. Merendino and colleagues collected seven such cases of the ‘Murmur on Top of the Head’ building on the work of others who provided a detailed description of mitral regurgitation and noted murmur radiation to the neck and cervical/lumbosacral spine. The majority of patients suffered from rheumatic heart disease or subacute bacterial endocarditis in native heart valves. Here, we report on a case of the ‘Murmur on Top of the Head’ and provide the reader/listener with a direct recording of the ‘Merendino murmur’ (as well as its spinal correlate) in an elderly woman with a bioprosthetic mitral valve.

Rothia dentocariosa causing intracranial mycotic aneurysm and ischaemic stroke

We describe a case of subacute bacterial endocarditis and mycotic brain aneurysm caused by Rothia dentocariosa due to untreated dental caries. R. dentocariosa is a rare cause of endocarditis that has a high incidence of aneurysmal and haemorrhagic complications. All patients with intracranial aneurysms who have signs of systemic infection should be considered to have mycotic aneurysms until proven otherwise. Dental habits should be included in regular medical assessment and dental care should be considered for patients presenting with infectious symptoms.

Gustav Mahler: betrayed love and endocarditis lenta

Gustav Mahler (1860-1911), a renown Austrian composer, died of subacute bacterial endocarditis, when antibiotic treatment was not yet available. Earlier in his life, he developed a mitral stenosis with systolic murmur which was a legacy of frequent throat infections and rheumatic fever which he had as a child. This condition was diagnosed accidentally when he was age forty-seven. Throughout his adult life, however, Mahler was asymptomatic and became a very successful conductor and musical director, as well as a prolific composer. His preoccupation with fate and death was notorious, probably having its roots in many deaths of his young siblings. The fatal blow came in a form of betrayal by his beloved wife, Alma, who had a love affair with a younger man. This sudden abandonment constituted a severe emotional stress, which superimposed on other past and present adverse events in his life, weakened his immune system. He developed bacteraemia-cum-endocarditis and finally succumbed to a cruel fate, a theme that repeatedly appears in his music.Key wordsMahler, endocarditis, betrayal, immune system, fate

Dermatologic Conundrum: A Cardiac Condition Masqueraded as a Dermatologic Distraction

A 38-year-old male presented to the emergency department (ED) complaining of extreme pain and a petechial rash on the left ankle for two weeks associated with generalized fatigue, intermittent fevers, and weight loss. He was discharged home from the ED on pain medications. He returned a few days later with a progressive rash that involved the entire left lower extremity to the level of the knee. He was diagnosed with herpes zoster (shingles) and was prescribed acyclovir and steroids. After several days, the patient presented for the third time to the ED. He developed a right lower extremity discomfort this time. The pain in bilateral lower extremities had become unbearable. His cardiac examination revealed a systolic murmur at the apex and a faint diastolic murmur at the left sternal border. Ultimately, he had an echocardiogram that demonstrated both a bicuspid aortic valve and large vegetation on the anterior leaflet of the mitral valve, and his blood culture grew Streptococcus mitis and Streptococcus oralis. The patient was subsequently diagnosed with subacute bacterial endocarditis thought to be sourced from his poor dentition. The diagnosis of infective endocarditis is often delayed due to its nonspecific clinical presentations. Our case displays an unusual skin manifestation of IE that may be present in the absence of other signs and symptoms of the disease.

Subacute bacterial endocarditis with vasculitis-like presentation; report of a case and literature review

Infective endocarditis is a diagnostic challenge since it could manifest as a systemic disease mimicking rheumatologic disorders by immunological mechanisms. We introduced a case of infective endocarditis which was a 62-year-old man who presented with weakness, weight loss, myalgia, arthritis, petechiae, hematuria and proteinuria and was admitted by a rheumatologist for evaluation of possible vasculitis.

Draft Genome Sequence of Campylobacter fetus subsp. fetus CITCf01, Isolated from a Patient with Subacute Bacterial Endocarditis

Campylobacter fetus is a Gram-negative, zoonotic pathogen and a member of the class Epsilonproteobacteria. We report the draft genome sequence of C. fetus subsp. fetus CITCf01, isolated from a patient with subacute bacterial endocarditis.