The Malignant Murmur: A Case of Nonbacterial Endocarditis

In this CardioNerds episode, Drs. Rick Ferraro and Dan Ambinder join Drs. Sahar Samimi and Lorraine Mascarenhas from Baylor College of Medicine at the Houston Livestock Show and Rodeo, where they have a booth each year, to dissect a fascinating case of nonbacterial thrombotic endocarditis (NBTE). The case centers on a 38‑year‑old woman with advanced endometrial cancer who presents with acute abdominal pain and is found to have splenic and renal infarctions alongside severe aortic regurgitation, despite persistently negative blood cultures. Through compelling clinical storytelling, they explore the pathophysiology of NBTE in a malignancy‑associated hypercoagulable state, the challenges of differentiating NBTE from culture‑negative infective endocarditis, and much more. The episode emphasizes thoughtful anticoagulation strategies, valvular surveillance, and the importance of coordinated multidisciplinary care in managing complex cancer‑associated cardiac disease.