Endocarditis on a surgical clock
Educational use only. Not clinically reviewed44-year-old man for calm recognition of mechanical failure, team activation, bounded surgical-referral intent, reassessment, and handoff practice. About 7 simulated minutes.
What you will practise
- Reconcile the breathlessness with an infection that is responding.
- Recognize mechanical failure rather than antimicrobial failure.
- Activate the endocarditis team and a surgical centre.
- Review the acute-regurgitation and timing evidence boundary.
- Record bounded surgical-referral intent, then reassess a strict later report.
- Hand off a pending surgical decision and active risk.
Review and sources
Not clinically reviewed. No clinician has signed this scenario.
- Delgado V, Ajmone Marsan N, de Waha S, et al. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J. 2023;44(39):3948-4042. doi:10.1093/eurheartj/ehad193. Endocarditis Team and Heart Valve Centre referral; surgical timing tiers of emergency (under 24 hours) for refractory pulmonary oedema or cardiogenic shock, and urgent (about 3 to 5 days) for heart failure or locally uncontrolled infection. Corrigendum Eur Heart J. 2025;46(11):1082.
- Fowler VG, Durack DT, Selton-Suty C, et al. The 2023 Duke-International Society for Cardiovascular Infectious Diseases Criteria for Infective Endocarditis. Clin Infect Dis. 2023;77(4):518-526. doi:10.1093/cid/ciad271.
- Baddour LM, Wilson WR, Bayer AS, et al. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications. Circulation. 2015;132:1435-1486. doi:10.1161/CIR.0000000000000296. Still the standing United States statement as of 2026-08-28 and predates the 2023 European guidance.
Open Sim Lab is an educational simulator, not for clinical use. It is not a clinical decision-support tool, not a dosing calculator, and is not validated for any decision affecting a real patient.