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
Other diagnostic factors
- hemorragias em estilhas
- infartos cutâneos
- dor torácica
- dorsalgia
- petéquias palatais
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
Diagnostic investigations
1st investigations to order
- hemoculturas
- ecocardiograma
- Hemograma completo
- proteína C-reativa
- perfil bioquímico sérico com glicose
- TFHs
- urinálise
- eletrocardiograma (ECG)
Investigations to consider
- fator reumatoide
- velocidade de hemossedimentação
- níveis do complemento
- TC cardíaca
- RNM
- Imagem nuclear e PET
Emerging tests
- volume plaquetário médio (VPM)
- anticorpos antibeta-2-glicoproteína I
- Dímero D e troponina I
Treatment algorithm
suspeita de endocardite infecciosa
valva nativa: endocardite confirmada
valva protética: endocardite confirmada
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
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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