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Infective endocarditis — SCE Acute Medicine MCQ

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HardCardiovascular medicineInfective endocarditisSCE Acute Medicine

A patient has Enterococcus faecalis bacteraemia, a new murmur and embolic renal findings. Transthoracic echocardiography is technically limited and shows no definite vegetation. What is the next cardiac investigation?

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

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Correct answer: D — Perform transoesophageal imaging after inconclusive transthoracic imaging

The best answer is “Perform transoesophageal imaging after inconclusive transthoracic imaging”. This is correct because clinical suspicion remains high and TEE has greater sensitivity for vegetations, abscess and prosthetic or posterior structures. A limited negative TTE cannot exclude infection. Delayed repeat imaging, exercise testing and biomarkers do not provide the required anatomical assessment.

Reference: British Infection Association published endocarditis guidance: https://academic.oup.com/eurheartj/article/44/39/3948/7243107