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Infective endocarditis with acute regurgitation — SCE Acute Medicine MCQ

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ModerateAcute Cardiac PresentationsInfective endocarditis with acute regurgitationSCE Acute Medicine

A 38-year-old man who injects drugs presents with fever and acute breathlessness. He has a new pansystolic murmur, pulmonary oedema on chest radiograph and blood cultures are positive for Staphylococcus aureus. Transthoracic echo shows a large mitral vegetation with severe regurgitation. What is the most appropriate next step in management?

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Correct answer: A — Urgent cardiology and cardiothoracic surgical discussion

Endocarditis complicated by severe acute valvular regurgitation and heart failure needs urgent specialist and surgical input alongside intravenous antibiotics. Oral therapy and discharge are unsafe in left-sided S aureus endocarditis with pulmonary oedema. Anticoagulation does not prevent septic emboli and may increase bleeding risk. The pearl is that heart failure is a major trigger for early surgery in infective endocarditis.

Reference: https://www.nice.org.uk/guidance/ng71#acute-medicine-order-74-1