system
Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.
user
A 32-year-old man is brought to the emergency department because of a 2-day history of confusion and rapidly progressive dyspnea. He has had a fever and chills for the past five days. Five years ago, he was diagnosed with hepatitis C. He has smoked two packs of cigarettes daily for 15 years and drinks one to two beers daily. He has a history of past intravenous heroin use. He appears pale, anxious, and in severe distress. His temperature is 39.3°C (102.7°F), respirations are 30/min, pulse is 59/min, and blood pressure is 80/50 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 75%. Examination shows multiple linear hemorrhages underneath the nails. There are nontender maculae on both palms and soles. Fine rales are heard bilaterally on auscultation of the chest. Cardiac examination shows an S3; a grade 3/6 high-pitched decrescendo early diastolic murmur is heard along the left sternal border and right second intercostal space. An x-ray of the chest shows a normal sized heart and pulmonary edema. An ECG shows P waves and QRS complexes that occur at regular intervals, but independently of each other. A transesophageal echocardiography (TEE) is most likely to show which of the following?
assistant
Perivalvular thickening with an echolucent cavity