A 35-year-old man with a history of intravenous drug use presents to the emergency department with a 1-week history of fever, malaise, and dyspnea. Vital signs show temperature 39.1°C, heart rate 118/min, respiratory rate 24/min, and blood pressure 128/82 mmHg. Physical examination reveals a new holosystolic murmur best heard at the left lower sternal border that increases with inspiration. Laboratory studies show WBC 14,500/μL and elevated inflammatory markers. Chest X-ray demonstrates multiple peripheral, wedge-shaped infiltrates. Blood cultures are pending but grow Staphylococcus aureus. Transthoracic echocardiography shows a 12-mm vegetation on a valve with right-to-left flow. The patient denies recent dental work, cardiac surgery, or prosthetic valve placement. Which valve is most likely affected in this patient?
- A)Tricuspid valveGABARITO
- B)Aortic valve
- C)Mitral valve
- D)Pulmonary valve
- E)Left main coronary artery ostium
Explicação
The tricuspid valve is the most commonly affected valve in intravenous drug users with infective endocarditis (IE), accounting for 50-60% of cases. This is because: (1) IV drug users inject directly into systemic veins, delivering bacteria preferentially to th... Ver explicação completa e trilha adaptativa →