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Infective endocarditis

Last reviewed: 6 Nov 2023
Last updated: 18 Nov 2022



History and exam

Key diagnostic factors

  • fever/chills
  • night sweats, malaise, fatigue, anorexia, weight loss, myalgias
  • weakness
  • arthralgias
  • headache
  • shortness of breath
  • meningeal signs
  • cardiac murmur
  • Janeway lesions
  • Osler nodes
  • Roth spots
More key diagnostic factors

Other diagnostic factors

  • splinter hemorrhages
  • cutaneous infarcts
  • chest pain
  • back pain
  • palatal petechiae
Other diagnostic factors

Risk factors

  • 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
More risk factors

Diagnostic investigations

1st investigations to order

  • CBC
  • serum chemistry panel with glucose
  • urinalysis
  • blood cultures
  • ECG
  • echocardiogram
More 1st investigations to order

Investigations to consider

  • rheumatoid factor
  • erythrocyte sedimentation rate
  • complement levels
  • cardiac CT
  • head MRI
More investigations to consider

Treatment algorithm


suspected infective endocarditis


native valve: confirmed endocarditis

prosthetic valve: confirmed endocarditis


at high risk of infective endocarditis



Ammara Mushtaq, MD

Clinical Assistant Professor

University of Florida

Division of Infectious Disease and Global Medicine




AM declares that she has no competing interests.


Dr Tracey Keteepe-Arachi, Dr Aneil Malhotra, and Dr Michael Papadakis would like to gratefully acknowledge Professor Sanjay Sharma, Dr Jason C. Schultz, Dr Nisha K. Lassi, and Dr Nandan S. Anavekar, previous contributors to this topic. JCS, NKL, NSA, and SS declare that they have no competing interests.

Peer reviewers

Vandana Desai, MD

Professor of Pediatrics

SMIMER Hospital




VD declares that she has no competing interests.

Lucieni Oliveira Conterno, MD, PhD


Clinical Epidemiology Unit

Marilia Medical School

Sao Paulo



LOC declares that she has no competing interests.

Andrew Wang, MD

Associate Professor of Medicine

Director, Cardiovascular Disease Fellowship Program

Duke University Medical Center




AW declares that he has no competing interests.

  • Infective endocarditis images
  • Differentials

    • Rheumatic fever
    • Atrial myxoma
    • Libman-Sacks endocarditis
    More Differentials
  • Guidelines

    • Prevention of viridans group streptococcal infective endocarditis
    • ACR appropriateness criteria: infective endocarditis
    More Guidelines
  • Patient leaflets


    More Patient leaflets
  • Calculators

    Endocarditis Diagnostic Criteria - Modified Duke Criteria

    More Calculators
  • Videos

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