Infective endocarditis (IE) often presents with nonspecific features, most commonly fever.
Historical sources of bacteremia should be considered, such as indwelling vascular catheters, intravenous drug use, and recent dental work.
Symptoms are often subtle and exam is often unrevealing, but may demonstrate cardiac murmur, peripheral emboli, Osler nodes, Roth spots, and Janeway lesions.
At least two sets of blood cultures taken at different times (ideally >6 hours if clinical status allows) should be obtained prior to initiation of antibiotic therapy.
An echocardiogram should be obtained in all suspected cases.
Antimicrobial therapy is guided by presentation, clinical findings, and organism virulence. The decision on the need for, and timing of, surgery should be made by the cardiac surgery team.
Infective endocarditis (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.
History and exam
Key diagnostic factors
- night sweats, malaise, fatigue, anorexia, weight loss, myalgias
- shortness of breath
- meningeal signs
- cardiac murmur
- Janeway lesions
- Osler nodes
- Roth spots
Other diagnostic factors
- splinter hemorrhages
- cutaneous infarcts
- chest pain
- back pain
- palatal petechiae
- prior history of infectious endocarditis
- presence of artificial prosthetic heart valves
- certain types of congenital heart disease
- postheart transplant (patients who develop a cardiac valvulopathy)
- presence of cardiac implanted electronic device or intravascular catheters (e.g., for hemodialysis)
- acquired degenerative valve disease
- mitral valve prolapse or bicuspid valve prolapse
- hypertrophic cardiomyopathy
- intravenous drug use
1st investigations to order
- serum chemistry panel with glucose
- blood cultures
Investigations to consider
- rheumatoid factor
- erythrocyte sedimentation rate
- complement levels
- cardiac CT
- head MRI
suspected infective endocarditis
native valve: confirmed endocarditis
prosthetic valve: confirmed endocarditis
at high risk of infective endocarditis
- Rheumatic fever
- Atrial myxoma
- Libman-Sacks endocarditis
- Prevention of viridans group streptococcal infective endocarditis
- ACR appropriateness criteria: infective endocarditis
EndocarditisMore Patient leaflets
Endocarditis Diagnostic Criteria - Modified Duke CriteriaMore Calculators
Venepuncture and phlebotomy: animated demonstration
How to perform an ECG: animated demonstrationMore videos
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer