Infective endocarditis

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.[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].