24th June 2026

You are asked to review a patient with new leg swelling and palpitations on the cardiology ward.

You are asked to review a patient with new leg swelling and palpitations on the cardiology ward. The patient is a 37-year-old female with infective endocarditis affecting the tricuspid valve. She has a past-medical history of childhood asthma, hyperthyroidism, paroxysmal AF, and poorly-controlled type 1 diabetes, complicated by recurrent infected ulcers, which are thought to be the source of her IE. On review, she has a respiratory rate of 18/min, has oxygen saturations of 96% on room air, a heart rate of 95 bpm, blood pressure of 118/58, and is afebrile. Her recent blood tests show normal renal function, improving inflammatory markers, and no growth in her most recent blood cultures. A recent chest XR shows clear lung fields. 

Her current medications are flucloxacillin, bisoprolol, levothyroxine, basal-bolus insulin, and citalopram. 

On examination, she has a new pan-systolic murmur loudest at the lower left sternal edge, clear lung fields, a raised JVP (5cm above the clavicle), and pitting oedema to both knees with no signs of cellulitis. An ECG shows sinus rhythm at a rate of 97 bpm.

What is the next best step in her management? 

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