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Prosthetic valve endocarditis — RCPSC IM MCQ

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HardInfectious DiseasesProsthetic valve endocarditisRCPSC IM

A patient with a prosthetic mitral valve has Staphylococcus aureus bacteremia, a new murmur and splenic infarcts, but technically limited transthoracic echocardiography is negative. What is the best next investigation?

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Correct answer: E — Perform transesophageal echocardiography urgently

The best answer is “Perform transesophageal echocardiography urgently”. Prosthetic material, S. aureus bacteremia and embolic phenomena create high pretest probability. TEE is more sensitive for prosthetic-valve vegetations and complications; a limited negative TTE cannot exclude disease. Repeat imaging may still be necessary if the first study is negative but bacteremia persists or new embolic or conduction findings emerge.

Reference: Infective endocarditis scientific statement, PubMed record: https://pubmed.ncbi.nlm.nih.gov/26373316/