Infective endocarditis

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

Consider historical sources of bacteraemia, such as indwelling vascular catheters, recent dental work, and intravenous drug use.

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

If you suspect IE, evaluate the patient urgently and seek early input from a cardiologist and an infectious disease or microbiology specialist. A multidisciplinary approach (e.g., with an ‘endocarditis team') is crucial for diagnosis and management.

Prioritise obtaining three sets of blood cultures taken at 30-minute intervals prior to initiation of antibiotic therapy and echocardiography. However, if the patient is unwell (e.g., with sepsis) do not delay empirical antibiotic therapy.

Treatment 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.