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Endocarditis is a life-threatening infection of the endocardium (inner lining of the heart). It usually affects the left-sided valves more than the right-sided valves and presents classically with a new murmur, fever, and peripheral stigmata. Though in the modern era, we have better antibiotics, better diagnostic imaging, and surgery that might cure infectious endocarditis (IE), it still carries significant mortality and morbidity. Here we present a 52-year-old male patient with hypertension and ischemic heart disease who presented with shivering, fever, and confusion for 2 days, fourteen days after cardiac intervention (PCI). Further trans-esophageal echocardiography was done due to the patient’s fulfillment of three minor and one major of Duke's criteria. Trans-esophageal echocardiography revealed flailing posterior mitral valve leaflets, 1.1 x 0.60 cm of vegetation, and severe eccentric mitral regurgitation. The patient was managed with vancomycin and gentamicin and referred to the cardiovascular surgery center. Post-PCI infective endocarditis is a rare and often missed diagnosis, so there should be a high level of suspension for those who present with signs and symptoms compatible with infective endocarditis.

Background and Aims:The etiological investigation of the potential cardiac source of acute ischemic stroke is important for the secondary prevention of recurrent and future embolization. Transthoracic echocardiography is one of the most useful investigations for the assessment of the potential cardiac etiology of ischemic stroke. Our aim is to evaluate echocardiographic findings in patients with acute ischemic stroke admitted to a tertiary care hospital in Mogadishu, Somalia. Methods: This was a retrospective observational study conducted in the neurology department of a tertiary care hospital in Mogadishu, Somalia. We enrolled 315 patients with acute ischemic stroke admitted to the hospital who had undergone transthoracic echocardiography between March 2019 and March 2022. We analyzed transthoracic echocardiography findings, ischemic stroke subtypes, and their associated comorbidities. We also compared the demographic data, comorbidity, and survival status of patients with abnormal echo findings to those with normal echo findings. Findings: The mean age of patients was 62±12 years. Co-morbidities were present in about 251 (80%) of the subjects, hypertension was the most common comorbidity 99 (31.4%), followed by diabetes 72 (23%), and hyperlipidemia 37 (11.7%). Overall cardiac pathology in this study was 170 (54%). Forty-seven (15%) of the patients had low ejection fraction on transthoracic echocardiography. Male patients had slightly less left ventricular systolic dysfunction than female patients. 100 (32%) had left ventricular diastolic dysfunction (LVDD), while 113 (36%) had left ventricular hypertrophy (LVH). Patients with hypertension and diabetes had more echo abnormalities compared to others (P-values of 0.047 and 0.024, respectively). More abnormal echo findings were seen in patients who died during hospitalization than in those who survived (P = 0.008). Severe left ventricular systolic dysfunction was associated with higher mortality (P < 0.001). Conclusion:Most patients with stroke in this study had abnormal echocardiograms; however, only a few had cardioembolic strokes. Abnormalities in echocardiography were more common in patients who died during hospitalization than in those who survived.

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