Case presentation A 74-year-old man with a biventricular pacemaker presented with generalized fatigue. He had a history of coronary artery disease, AF, and cardiac failure. He denied chest pain or any other symptom. Physical examination Blood pressure - 116/80 mmHg Pulse - 72 beats/minute Respiratory rate - 21 breaths/minute Edema in his lower extremities Jugular venous distension Decreased bibasilar breath sounds Laboratory investigations showed normal WBC count but elevated CRP. He had a troponin level of 0.22.
Chest X-ray revealed cardiomegaly without any indication of vascular effusion or congestion. The patient also developed a fever of 39.2°C. Blood cultures showed gram-positive rods. An echocardiogram was done, which revealed a left ventricular ejection fraction of 20–25%, moderate mitral and tricuspid regurgitation, and severe diffuse hypokinesis. What can be the possible…
