Persistent Fever With Aortic Valve Endocarditis

A 25-year-old woman was admitted to the hospital for suspected infective endocarditis. Nine days prior to the admission she had the onset of fever, shaking chills, diaphoresis, extreme fatigue, and anorexia. A congenital bicuspid aortic valve with mild aortic insufficiency had been documented by cardiac catheterization at 6 years of age. On admission, her abnormal physical findings were a BP of 120/40 mm Hg, a pulse rate of 92 beats per minute, and a temperature of 39.17 °C. The upstroke and volume of peripheral pulses were increased. The cardiac impulse was in the fifth left intercostal space at the midclavicular line. S₁was normal and S₁was increased in intensity. A grade 2/6 systolic ejection murmur was heard at the base. A grade 3/6 early diastolic decrescendo murmur was best heard at the fourth left lower sternal border and radiated to the apex. An ECG and a chest