Infective Endocarditis: The Daily PANCE Blueprint

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Infective Endocarditis: The Daily PANCE Blueprint

A 72-year-old female with sick sinus syndrome (s/p pacemaker) presents to your clinic with fever and chills. On a physical exam, you appreciate a new murmur located at the left 5th intercostal space at the midclavicular line. You also notice petechiae on the patient’s conjunctivae. Which of the following is the most likely diagnosis?

A. Bacterial pneumonia
B. Pericarditis
C. Rheumatic fever
D. Infective endocarditis
E. Pleural effusion

Answer and topic summary

The answer is D. Infective endocarditis

The patient has infective endocarditis (IE), which is an infection of the endocardial surface of the heart. Risk factors include pre-existing valvular or congenital heart disease, IVDU, indwelling cardiac devices, IV catheter, or recent dental/surgical procedure. The most common symptoms include fever (90%), new murmur (85%), petechiae (20-50%). Other textbook findings include Janeway lesions (non-tender macules on palms/soles), Osler nodes (tender nodules on pads of fingers/toes), and Roth spots (hemorrhagic lesions of retina). The best diagnostic test is a transesophageal echocardiogram. The modified Duke criteria can be used as a diagnostic guide but must be interpreted in light of pretest probability. At least 3 sets of blood cultures should be obtained. Treatment includes IV antibiotics and removal of any infected device.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Cardiology ⇒ Traumatic, infectious, and inflammatory heart conditions ⇒ Acute and subacute bacterial endocarditis

Also covered as part of the Emergency Medicine EOR, Internal Medicine EOR, and Family Medicine EOR topic list