American Board of Internal Medicine (ABIM) Certification Practice Exam

Which scenario warrants early surgical intervention in infective endocarditis?

1. New heart block

2. Chronic fatigue

3. Chest pain on exertion

4. Transient ischemic attacks

The correct answer is: New heart block

Infective endocarditis can lead to various complications, some of which may necessitate urgent surgical intervention to prevent life-threatening outcomes. The scenario in which early surgical intervention is warranted is the development of new heart block. New heart block indicates significant structural or electrical disturbances due to the infection, often related to the involvement of the conduction system by the infective process or the presence of an abscess. This condition can compromise cardiac function and may lead to severe bradycardia or even asystole, posing an immediate risk to the patient's life. In the context of infective endocarditis, heart block likely signifies the need for source control, such as valve replacement or repair, to manage the infection and restore adequate electrical conduction. In contrast, chronic fatigue, chest pain on exertion, and transient ischemic attacks are significant symptoms that require evaluation but do not immediately demand surgical intervention. Chronic fatigue could be due to the ongoing inflammatory process but is not a direct indication for surgery. Chest pain on exertion may indicate complications such as ischemia, but it does not carry the same urgency as new heart block. Transient ischemic attacks, while concerning, reflect temporary neurological deficits rather than an immediate risk of life-threatening arrhythmias or conduction