skip to main content

IE with Acute Heart Failure — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardCardiologyIE with Acute Heart FailureRACP Adult Medicine

A 75-year-old man with AF on apixaban presents 10 days post-colonoscopy with fever (38.8°C) and rigors. Blood cultures grow Enterococcus faecalis. TEE shows a 12 mm vegetation on the mitral valve. He develops acute heart failure with pulmonary oedema. What is the most appropriate surgical indication?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Urgent surgery for acute heart failure with severe valvular regurgitation

Infective endocarditis with acute heart failure from severe valvular regurgitation is a Class I indication for urgent surgery (within 24–48 hours). This is the strongest surgical indication in IE. Other surgical indications include: uncontrolled infection (abscess, fistula), persistent bacteraemia >7 days on appropriate antibiotics, and prevention of embolism (vegetation >10 mm after embolic event).

Reference: ESC – 2023 – IE Guidelines; eTG Antibiotic 2025