Infective endocarditis

Last reviewed: 21 Apr 2022
Last updated: 13 Aug 2021

Summary

Definition

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

INITIAL

suspected infective endocarditis

ACUTE

native valve: confirmed endocarditis

prosthetic valve: confirmed endocarditis

ONGOING

at high risk of infective endocarditis

Contributors

Authors

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.

Acknowledgements

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

Gujarat

India

Disclosures

VD declares that she has no competing interests.

Lucieni Oliveira Conterno, MD, PhD

Director

Clinical Epidemiology Unit

Marilia Medical School

Sao Paulo

Brazil

Disclosures

LOC declares that she has no competing interests.

Andrew Wang, MD

Associate Professor of Medicine

Director, Cardiovascular Disease Fellowship Program

Duke University Medical Center

Durham

NC

Disclosures

AW declares that he has no competing interests.

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