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Endocardite infecciosa

Last reviewed: 24 Sep 2025
Last updated: 29 Jan 2025

Summary

Definition

History and exam

Key diagnostic factors

  • febre/calafrios
  • sudorese noturna, mal-estar, fadiga, anorexia, perda de peso, mialgias
  • fraqueza
  • artralgias
  • cefaleia
  • dispneia
  • sinais meníngeos
  • sopro cardíaco
  • Lesões de Janeway
  • Nódulos de Osler
  • Manchas de Roth
Full details

Other diagnostic factors

  • hemorragias em estilhas
  • infartos cutâneos
  • dor torácica
  • dorsalgia
  • petéquias palatais
Full details

Risk factors

  • história prévia de endocardite infecciosa
  • presença de valvas cardíacas protéticas artificiais
  • certos tipos de cardiopatia congênita
  • pós-transplante cardíaco (pacientes que desenvolvem uma valvulopatia cardíaca)
  • pacientes imunocomprometidos
  • presença de dispositivo cardíaco eletrônico implantado ou cateteres intravasculares (por exemplo, para hemodiálise)
  • doença valvar degenerativa adquirida
  • prolapso de valva mitral ou prolapso de valva bicúspide
  • cardiomiopatia hipertrófica
  • uso de substâncias por via intravenosa
  • febre Q crônica
Full details

Diagnostic investigations

1st investigations to order

  • hemoculturas
  • ecocardiograma
  • Hemograma completo
  • proteína C-reativa
  • perfil bioquímico sérico com glicose
  • TFHs
  • urinálise
  • eletrocardiograma (ECG)
Full details

Investigations to consider

  • fator reumatoide
  • velocidade de hemossedimentação
  • níveis do complemento
  • TC cardíaca
  • RNM
  • Imagem nuclear e PET
Full details

Emerging tests

  • volume plaquetário médio (VPM)
  • anticorpos antibeta-2-glicoproteína I
  • Dímero D e troponina I

Treatment algorithm

INITIAL

suspeita de endocardite infecciosa

ACUTE

valva nativa: endocardite confirmada

valva protética: endocardite confirmada

ONGOING

com alto risco para endocardite infecciosa

Contributors

Authors

Carl Zehner, MD

Assistant Professor of Medicine

University of Texas MD Anderson Cancer Center

Department of Cardiology

Houston

TX

Declarações

CZ declares that he has no competing interests.

Agradecimentos

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.

Disclosures

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.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation. 2015 Oct 13;132(15):1435-86.Full text  Abstract

Delgado V, Ajmone Marsan N, de Waha S, et al. 2023 ESC guidelines for the management of endocarditis. Eur Heart J. 2023 Oct 14;44(39):3948-4042.Full text  Abstract

Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2021 Feb 2;143(5):e72-227.Full text

Wilson WR, Gewitz M, Lockhart PB, et al. Prevention of viridans group streptococcal infective endocarditis: a scientific statement from the American Heart Association. Circulation. 2021 May 18;143(20):e963-78.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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