We present a rare case of endocarditis in a 33-year-old woman with a splenectomy. The patient presented with meningeal symptoms and was diagnosed with endocarditis on the medical admissions unit using a portable echocardiography machine. Bordetella holmesii was cultured from the blood on admission and the patient underwent subsequent aortic valve replacement. We discuss the importance of echo skills within the specialty of acute medicine and the benefits of swift senior review at the front door. We emphasise the guidelines on antibiotic prophylaxis for the post-splenectomy patient as well as discuss the pathogen B holmesii and its growing association of septicaemia in asplenic individuals.