20th June 2024

A 56-year-old man is admitted to hospital with a 4-week history of fevers, malaise and anorexia

A 56-year-old man is admitted to hospital with a 4-week history of fevers, malaise and anorexia. He has a history of IV drug use and is HIV positive. He is pyrexial, blood pressure is 104/62 mmHg, pulse rate is 120/min, respiratory rate is 22/min and SpO2 is 94% on room air. On examination, there is a pansystolic murmur over the left sternal edge. He has previously been treated for infective endocarditis complicated by septic pulmonary emboli. His blood culture is positive for Methicillin sensitive staphylococcus aureus. The echocardiogram shows 15mm vegetation at the tricuspid valve. He is started on Flucloxacillin and Gentamicin.

Which of the following complications is most likely to lead to this patient having cardiothoracic surgery?

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