Case vignette
34yo F brought in by ambulance for SOB, AMS, and F. She has history of IVDU but cannot provide further information.
HR 110, BP 105/60, T 39, RR 22, SpO2 94% on 2L NC.
She appears toxic and has rhonchorous breath sounds bilaterally with a systolic murmur loudest at the cardiac apex.
What do you see?
CP3 PLA: echogenic/thickened AV, echogenic/thickened MV, hypertrophic LV, small pericardial effusion
CP3 Subxiphoid: echogenic mobile debris on tricuspid valve, thickened/echogenic posterior mitral valve leaflet, small pericardial effusion
What do you do next?
Septic work up is obtained with CXR demonstrating multofical opacities, fluids, broad spectrum antibiotics, and 3 blood cultures separated over time. The patient's mental status improves and she is admitted to medicine for a formal TTE, which again shows TV endocarditis 2/2 drug use as you suspected.
Teaching points. Endocarditis can be challenging to identify on POCUS but is possible to. Hyperechoic/thickened valves can suggest sclerosis or endocarditis. Incorporate clinical context to modify your pre-test probability.
Residents/staff: Dr. Josephine Livingston, Dr. Jimmy Heilman
Endocarditis