Infective Endocarditis | MRCS Part B OSCE Revision

Structural cardiac: rheumatic heart disease (valve scaring), congenital heart disease (VSD, PDA, bicuspid aortic valve), previous IE
Prosthetic material: prosthetic heart valves, implantable devices (PPM, ICD, LVAD)
Bacteraemia sources: IVDU (right-sided IE), poor dentition, IV lines, UTI (Enterococci), colorectal cancer (Streptococcus bovis)
Immunosuppression: HIV, diabetes mellitus, malignancy, long-term steroid use

Clinical Scenario

Mr. Daniel Okafor, 34, known intravenous drug user. Presents to the emergency department with a 3-week history of fevers, night sweats, and progressive dyspnoea. He has a known history of rheumatic heart disease affecting his mitral valve. On examination he is pyrexial (38.6°C), has a new pansystolic murmur audible.