MCQ 29: Infective endocarditis in i/v drug abuser

Q. A 25 years old gentleman is brought to emergency with the complaint of fever for 7 days. He drinks five units of alcohol per day and admitted to regular intravenous drug abuse. On examination, he is febrile, has tachypnea and tachycardia. Blood pressure is 108/70. JVP is elevated and there is a murmur all over the precordium. What will be most likely cause of infection in this patient?
A. Staphylococcus epidermidis
B. Streptococcus viridans
C. Staphylococcus aureus
D. Pneumocystis carinii

Answer: Staphylococcus aureus

Explanation:
With given history and abuse of i/v drugs, tricuspid valve endocarditis is most likely diagnosis. Among, i/v drug abusers, Staphylococcus aureus is most common cause.

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ECG Spotter

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High heart rate

The patient contacts the doctor over phone with this report. Obviously anxious because of his high heart rate (199 beats per minute) as detected by ECG machine. Should he be worried about this and come to emergency department as soon as possible? Correct answer- ECG machine has calculated his heart rate incorrectly. Heart rate is around 100 beats per minute. Other findings in this ECG include ST segment elevation in anterior chest leads along with presence of Q waves, denoting old MI changes with possibly development of LV aneurysm. In such cases, ST segment elevation can persist for long periods. Now, should he come to emergency department? Not because of detection of high heart rate. But, if he is having symptoms such as shortness of breath or chest pain, he should visit emergency department. Otherwise, if he is asymptomatic, he can schedule a regular visit with his cardiologist.

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