A 28 yo male with history of IV drug use presents with fever, tachycardia and hypotension.  A bedside cardiac ultrasound is performed.  What's the diagnosis?  (scroll down for answer)

Answer:  Infective Endocarditis with mitral valve vegetation

• Vavular vegetations are seen on ultrasound as mobile masses that move independently from their respective valves
• 50% of vegetations in IV drug users involve the tricuspid valve
• Causative organisms in IV drug users are most commonly S aureus(about 50%), followed by Strep (Groups A, C, and G), enterococcus, psuedomonas, and candida
• Definitive diagnosis is made using the Duke Criteria.