24th June 2026

A patient is seen in the cardiology outpatient’s clinic one year following a trans-catheter aortic valve implantation for aortic stenosis.

A patient is seen in the cardiology outpatient’s clinic one year following a trans-catheter aortic valve implantation for aortic stenosis. He reports a slight increase in shortness of breath and fatigue for the last 2 months, but had put this down to not getting out as much following his surgery and during the pandemic. On examination, he is not dyspnoeic at rest. He has a diastolic murmur loudest at the left lower sternal border (which was not present previously). His lung fields are clear. He has had an echocardiogram prior to his appointment, which shows evidence of mild aortic regurgitation, preserved biventricular function, and no vegetations. Recent blood tests show that he is slightly anaemic, with a Hb of 100 g/L (previously 120 g/L at the time of surgery). 

Which feature of his presentation would most warrant further investigation for infective endocarditis as a cause of his symptoms?

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