Murmur and weight loss: is it subacute bacterial endocarditis?

A 65-year-old retired statistician, Mr PG, is reporting six weeks of lethargy and mild weight loss. He has been married for 39 years, is a lifelong nonsmoker and has no significant past medical history. He usually plays tennis three times a week but is now playing only once a week because of his increased fatigue. There is no dyspnoea or chest pain associated with this fatigue. In spite of the decrease in physical activity, his weight has dropped by 6 kg from 77 kg to 71 kg. He has had no rigors or night sweats, has no personal or family history of cancer, nor any additional symptoms that may suggest a malignancy, and his National Screening faecal occult blood test was negative this year. You ask briefly about his mood and marriage, which he insists are fine. ‘Just tell me what’s wrong, doc’, he says.

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