Infective endocarditis

Last reviewed: 26 Aug 2022
Last updated: 08 Jul 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • fever/chills
  • cardiac murmur
  • night sweats, malaise, fatigue, anorexia, weight loss, myalgias
  • weakness
  • arthralgias
  • headache
  • shortness of breath
  • meningeal signs
  • Janeway lesions
  • Osler nodes
  • Roth spots
  • splinter haemorrhages
Full details

Other diagnostic factors

  • cutaneous infarcts
  • chest pain
  • back pain
  • palatal petechiae
Full details

Risk factors

  • prior history of infectious endocarditis
  • presence of artificial prosthetic heart valves
  • certain types of congenital heart disease
  • post-heart transplant (patients who develop a cardiac valvulopathy)
  • presence of cardiac implanted electronic device or intravascular catheters (e.g., for haemodialysis)
  • acquired degenerative valve disease
  • mitral valve prolapse (MVP) with valvular regurgitation
  • hypertrophic cardiomyopathy
  • intravenous drug use
Full details

Diagnostic investigations

1st investigations to order

  • blood cultures
  • echocardiography
  • full blood count
  • C-reactive protein
  • serum urea, electrolytes, and glucose
  • liver function tests
  • urinalysis
  • ECG
Full details

Investigations to consider

  • rheumatoid factor/other immunological blood tests
  • erythrocyte sedimentation rate
  • complement levels
  • computed tomography
  • magnetic resonance imaging
Full details

Treatment algorithm

INITIAL

suspected infective endocarditis

ACUTE

native valve: confirmed infective endocarditis

prosthetic valve: confirmed infective endocarditis

ONGOING

at high risk of infective endocarditis

Contributors

Expert advisers

Mamta Buch, MBChB, PhD, FRCP

Consultant Cardiologist

Manchester University NHS Foundation Trust

Manchester

UK

Disclosures

MHB has been a faculty member for the British Heart Valve Society, the British Cardiovascular Intervention Society, and the Congenital and Structural Interventions Frankfurt educational conferences. MHB has also received speaker honoraria from Edwards Lifesciences and Medtronic relating to transcatheter heart valve intervention.

Acknowledgements

BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:

Tracey Keteepe-Arachi BSc (Hons), MBBS, MRCP (UK)

Cardiology Specialist Registrar and Clinical Research Fellow

Department of Cardiovascular Sciences

St George's Hospital Medical School

University of London

London

UK

Disclosures: TKA declares that she has no competing interests.

Aneil Malhotra MA (Hons), MSc, MB BChir, MRCP (UK)

Cardiology Specialist Registrar and Clinical Research Fellow

Department of Cardiovascular Sciences

St George's Hospital Medical School

University of London

London

UK

Disclosures: AM is an author of a number of references cited in this topic.

Michael Papadakis MD, MRCP (UK)

Clinical Lecturer in Cardiology

St George's University of London

London

UK

Disclosures: MP declares that he has no competing interests.

Peer reviewers

Bernard Prendergast, BMedSci, BM, BS, MD, FRCP, FESC

Professor of Interventional Cardiology and Valvular Heart Disease

St Thomas' Hospital

London

UK

Disclosures

BP declares that he has no competing interests.

Brian Angus, BSc MBChB, MD, FRCP

Professor

Oxford University

The John Radcliffe

Oxford

UK

Disclosures

BA declares he has no competing interests.

Editors

Annabel Sidwell,

Section Editor, BMJ Best Practice

Disclosures

AS declares that she has no competing interests.

Tannaz Aliabadi-Oglesby,

Lead Section Editor, BMJ Best Practice

Disclosures

TAO declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

Annabel Sidwell,

Comorbidities Editor, BMJ Best Practice

Disclosures

AS declares that she has no competing interests.

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