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Infective endocarditis with heart failure — SCE Acute Medicine MCQ

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HardAcute Cardiac PresentationsInfective endocarditis with heart failureSCE Acute Medicine

A 59-year-old man is assessed on the acute medical unit. He has fever, positive blood cultures for Staphylococcus aureus and a new regurgitant murmur. He is breathless with pulmonary oedema. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate investigation?

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Correct answer: A — Urgent transthoracic echocardiography

Urgent transthoracic echocardiography is the best answer because suspected endocarditis with new heart failure needs urgent echocardiographic assessment for valve destruction and surgical indications. Twelve-lead ECG and serial high-sensitivity troponin is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Staphylococcus aureus bacteraemia should trigger active endocarditis assessment.

Reference: NICE NG196?; ESC infective endocarditis guideline