Case 14-1978: Changing Cardiac Murmurs in a 26-Year-Old Woman

Presentation of Case A 26-year-old woman was admitted to the hospital because of heart murmurs. There was a history of scarlet fever at the age of seven years. At 21 years a cardiac murmur was heard, and a diagnosis of mitral stenosis was made. Because of allergy to penicillin she was begun on daily prophylaxis with sulfadiazine. She remained free of symptoms and worked as a head nurse in the Coronary Care Unit of another hospital. Twenty-eight months before admission examination disclosed a Grade 4 systolic murmur and a Grade 3 diastolic murmur along the left sternal border; no definite.