7th March 2024

A 47-year-old man presents to A&E with shortness of breath, fever and feeling generally unwell.

A 47-year-old man presents to A&E with shortness of breath, fever and feeling generally unwell. He admits to regularly injecting heroin with his friends and sharing needles with them. His last heroin use was 4 days ago. On examination, he appears unwell, with a pansystolic murmur best heard in his left lower parasternal area. He has a raised JVP with giant V waves and a left parasternal heave. Auscultation of his lungs reveals good air entry bilaterally and a mild wheeze. He is a smoker with a 30 pack-year history. He drinks 40 units of alcohol a week for the past 10 years since separating from his wife. He is unemployed and currently homeless. He has no significant travel history. What is the most likely diagnosis? 

Select the SINGLE most appropriate option from the list below. Select ONE option only.