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Suspected infective endocarditis — RACP Adult Medicine MCQ

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HardCardiologySuspected infective endocarditisRACP Adult Medicine

A 42-year-old man who injects drugs has fever, pleuritic chest pain and multiple cavitating lung nodules on CT. Blood cultures grow Staphylococcus aureus. Examination reveals a new pansystolic murmur at the left lower sternal edge. What is the most appropriate investigation?

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Correct answer: B — Transthoracic echocardiography followed by transoesophageal echocardiography if nondiagnostic

Right-sided infective endocarditis with septic pulmonary emboli should be assessed with echocardiography, beginning with transthoracic imaging and escalating if diagnostic uncertainty remains. CT coronary angiography and cardiac MRI do not replace valve imaging in this setting. V/Q scanning and interval chest CT do not establish the intracardiac source.

Reference: Therapeutic Guidelines (eTG) Antibiotic; CSANZ endocarditis guidance