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Prevalence Clinical features Investigations Therapy Prevention Prognosis

Clinical features Ask about valvular heart disease b  (including mitral valve prolapse) b   which valves are affected b   severity of disease b   any recent valvular surgery in the last 2 months a   any prosthetic valves b   previous rheumatic fever b   previous endocarditis b   intravenous drug use b   any infectious episode in the last 3 months b  particularly superficial wound infections a   any skin wounds in the last 3 months  b   Look for c fever c rigors a new or changed heart murmur c complications neurological involvement (headache, mental state changes) emboli: strokes, petechiae (including palettal, Janeway lesions, conjunctival haemorrhages, Roth spots) evidence of heart failure or dyspnoea hepatomegaly splenomegaly

Expiry date: July 2003
Levels of Evidence used in grading these guides