Valvular insufficiency (regurgitation) Quiz: Ace Your Exams
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A 71-year-old man presents to the emergency department due to several hours of shortness of breath. His symptoms started abruptly a few hours ago. Over the past two weeks, he has had fevers with rigor at night. He has no significant past medical history and does not take any medication. Temperature is 38.3ºC (101.0ºF), pulse is 108/min, respiratory rate is 18/min, blood pressure is 81/50 mmHg, and SpO2 is 92% on 3 liters nasal cannula oxygen. On physical examination, the patient appears listless. There is no accessory muscle use. Small tender nodules on multiple fingers and non-tender red spots on the soles of both feet are seen. Small dark lines are present in several nailbeds. Mucous membranes are moist. Cardiac auscultation reveals a holosystolic murmur heard best at the left fifth intercostal space. There is no lower extremity edema. Intravenous (IV) access is established, and laboratory studies are obtained. Which of the following is the best next step in management?
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