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IE with Haemorrhagic Stroke — RACP Adult Medicine MCQ

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HardCardiologyIE with Haemorrhagic StrokeRACP Adult Medicine

A 55-year-old man with MSSA native valve endocarditis (mitral valve, 8 mm vegetation) has a large embolic stroke (MCA territory, haemorrhagic transformation on day 3). He has no heart failure and bacteraemia is clearing on IV flucloxacillin. What is the most appropriate surgical timing?

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Correct answer: B — No surgery needed — medical therapy alone

Embolic stroke with haemorrhagic transformation is a relative contraindication to early cardiac surgery (risk of worsening intracranial haemorrhage with cardiopulmonary bypass and heparinisation). Guidelines recommend delaying surgery for ≥4 weeks after a haemorrhagic stroke if possible. If there is no other urgent surgical indication (no HF, bacteraemia clearing), medical therapy alone is appropriate while the stroke matures.

Reference: ESC – 2023 – IE Guidelines; AHA/ACC 2024 IE