A 52-year-old female is evaluated in the hospital for left arm and left leg weakness of 12 hours duration. She has a 4-month history of progressive dyspnea on exertion, fatigue, low-grade fever, and arthralgia. Muscle strength is 4/5 in the left arm and left leg. MRI of the brain reveals multiple small infarcts. The echocardiogram (echo) is shown below.
Which of the following conditions is most likely responsible for the patient's presentation?
a) Ischemic cardiomyopathy
b) Endocarditis
c) Rheumatoid arthritis
d) Systemic lupus erythematosus
