Infective endocarditis

Infective endocarditis (IE) often presents nonspecifically, most commonly with fever and signs/symptoms of embolism.

Historical sources of bacteremia should be considered, such as indwelling vascular catheters, intravenous drug use, and recent dental work.

Symptoms are often subtle and examination is often unrevealing, but may demonstrate cardiac murmur, peripheral emboli, Osler nodes, Roth spots, and Janeway lesions.

In cases of suspected IE, the patient should be evaluated urgently and early input from cardiology and an infectious disease or microbiology specialist should be sought. A multidisciplinary approach (e.g., with an “endocarditis team”) is crucial for diagnosis and management.

At least three sets of blood cultures taken at different sites and at different times (ideally >6 hours between the first and last samples if clinical status allows) should be obtained prior to initiation of antibiotic therapy and echocardiography. However, if the patient is unwell (e.g., with evidence of sepsis) do not delay empiric antibiotic therapy.

Antimicrobial therapy is guided by presentation, clinical findings, and organism virulence.

IE is an infection involving the endocardial surface of the heart, including the valvular structures, the chordae tendineae, sites of septal defects, or the mural endocardium.[1]Mylonakis E, Calderwood SB. Medical progress: infective endocarditis in adults. N Engl J Med. 2001 Nov 1;345(18):1318-30. http://www.ncbi.nlm.nih.gov/pubmed/11794152?tool=bestpractice.com [Figure caption and citation for the preceding image starts]: Gross pathology of subacute bacterial endocarditis involving mitral valveCDC/Dr Edwin P. Ewing, Jr.; used with permission [Citation ends]. Chronic IE is not covered in this topic.