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Infective endocarditis with acute severe mitral regurgitation — SCE Acute Medicine MCQ

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HardAcute Cardiac PresentationsInfective endocarditis with acute severe mitral regurgitationSCE Acute Medicine

A 38-year-old man who injects drugs presents with fever and acute breathlessness. He has a new pansystolic murmur, splinter haemorrhages, bilateral crackles, CRP 186 mg/L and blood cultures grow Staphylococcus aureus. Echocardiography shows a 14 mm mitral vegetation with severe regurgitation. What is the most appropriate next step in management?

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Correct answer: D — Discuss urgently with the endocarditis team and cardiothoracic surgery

Severe acute valve regurgitation with heart failure and S aureus endocarditis warrants urgent specialist endocarditis and surgical discussion. Waiting until antibiotics are completed risks fatal decompensation. Anticoagulation does not prevent septic emboli and may increase intracranial bleeding risk if embolic stroke occurs. The key decision is recognising a surgical complication rather than treating endocarditis as antibiotics alone.

Reference: NICE NG195, ESC infective endocarditis guideline