Endocarditis Case 1

A 72-year-old retired teacher presents with shortness of breath, temperature of 39^oC and dull chest pain. She reports being unwell for a couple of weeks with ‘flu’ that has ‘knocked her off her feet’. She has a blood pressure of 140/60 mm Hg, heart rate 120/min and SpO₂ 93% on air. You detect bi-basilar crackles and a systolic murmur. The rest of her examination is unremarkable.

Rank the following differential diagnosis in likelihood of possibility, with 1 being the most likely and 5 being the least likely.

At this time you are trying to ascertain the source of her infection and must look for common causes that would guide you in the correct direction.
Her chest X-ray reveals mild heart failure; inflammatory markers are raised with a CRP of 184 and a white cell count of 18 with neutrophilia. Of note is Hb of 10.2 g%. You decide to examine her fundi and detect what you think are Roth spots.

Please choose three non-cardiac examination findings of infective endocarditis.

What are the next three staps in the management of this patient?