20th June 2024

A 65-year-old gentleman is brought to the emergency department with a fever and confusion

A 65-year-old gentleman is brought to the emergency department with a fever and confusion. His wife tells you his fever has been ongoing for weeks. She also describes rigors and a loss of appetite for one week. He has a history of hypertension and is taking amlodipine. His temperature is 38 degrees Celsius, pulse is 104 bpm and blood pressure is 104/62 mmHg. His respiratory rate is 20/min and SpO2 is 95% on room air. On examination, he is confused and not orientated. There is a pansystolic murmur with bilateral basal crackles on auscultation.

Which of the following conditions puts him at most risk of developing infective endocarditis?

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