Infective Endocarditis

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 and was seen by his GP 6 weeks ago with a dental abscess. On examination he is pyrexial (38.6°C), has a new pansystolic murmur audible at the apex, painful nodules on the finger pulps, and non-blanching red macules on his palms. Blood cultures have been sent. A transthoracic echocardiogram has been requested.