12th March 2024

A 46-year-old female is currently on the cardiology ward, being treated for native valve infective endocarditis of the aortic valve.

A 46-year-old female is currently on the cardiology ward, being treated for native valve infective endocarditis of the aortic valve. Three sets of blood cultures have so far been reported as having grown ‘Gram-positive cocci in clusters’, but the complete report is still pending. She is currently on day 11 of ampicillin, flucloxacillin and gentamicin as part of empirical antimicrobial therapy. You have been called to review her as she has had several episodes of witnessed collapses on the ward. The most recent collapse occurred whilst she was mobilising to the toilet. Nursing staff report serial lying and standing blood pressures have been normal and that she appears to regain full alertness within a few seconds of each episode. They deny any seizure activity but highlight she has had persistent pyrexia for the last three days. What is the most likely explanation for this patient’s recurrent collapses?

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