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Endocarditis with heart failure — SCE Acute Medicine MCQ

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HardAcute Cardiac PresentationsEndocarditis with heart failureSCE Acute Medicine

A 76-year-old man presents with acute chest symptoms with haemodynamic concern. Relevant history includes cardiovascular risk factors or structural heart disease. On assessment, haemodynamic findings and ECG changes are present. Investigations show valve vegetation with severe regurgitation and heart failure. What is the most appropriate next step in management?

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

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Correct answer: D — Discuss urgently with the endocarditis team for IV antibiotics and surgical assessment

The key discriminator is that valve vegetation with severe regurgitation and heart failure, which makes Discuss urgently with the endocarditis team for IV antibiotics and surgical assessment the single best answer. Optimise chronic medication and discharge is less appropriate because it does not address the dominant acute risk in the vignette; Give controlled oxygen and senior review would fit a different presentation or later stage of care. Arrange routine outpatient follow-up and Give intravenous fluids with reassessment are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: NICE NG84; ESC endocarditis guideline