Heard High and Low: What Is It?

A 63-year-old white male presented with altered mental status after falling off a couch. Initially, he was found in hemorrhagic shock as a result of splenic laceration and acute upper gastrointestinal bleed. He was fluid resuscitated and stabilized. Past medical history was significant for end-stage renal disease on hemodialysis, alcoholic cirrhosis, hyperlipidemia, and hypertension. Hospitalization was complicated by Enterococcus faecalis sepsis, and appropriate antibiotics were started. A concern for endocarditis has been raised. An echocardiogram was performed, as shown below.

Figure 1

Video 1

What is the most likely diagnosis?

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