A 2 year old known case of RHD presents with 3 wks history of fever, hematuria and palpitation diagnosis is –

Any fever in a patient with known heart disease raises the question of endocarditis. It can occur over the mitral valve or Aortic valve in patient with Rheumatic fever. The minimum criteria for the diagnosis of endocarditis consists of unexplained fever of 7-10 days duration in a patient with known heart disease. If this is associated with other clinical manifestations of endocarditis, the diagnosis becomes more firm. (In this case besides fever, hematuria and palpitations are other 2 symptoms of endocarditis). Major clinical manifestation of infective endocarditis: -