Infective endocarditis is an infection of the heart valves or inner lining of the heart, most often caused by Staphylococcus aureus or streptococci. Risk is highest with injection drug use, prosthetic valves or prior endocarditis, and infected clumps can break off and travel to the brain, lungs or other organs.
Key symptoms
- Fever, chills and night sweats
- Fatigue, weight loss and muscle aches
- Shortness of breath from valve damage
- Sudden stroke symptoms, back pain or painful fingertips
What you find on exam
- New or changing heart murmur
- Splinter hemorrhages, Janeway lesions, Osler nodes
- Roth spots on fundoscopy
- Injection marks, poor dental health, enlarged spleen
Tests
- Three sets of blood cultures from separate sites before antibiotics
- Transthoracic echo, then transesophageal echo if unclear or a prosthetic valve
- Blood count, CRP, ESR and urinalysis for blood
- Duke criteria to confirm the diagnosis
Treatment basics
- Empiric IV vancomycin plus ceftriaxone after cultures are drawn
- Adjust to culture results; usually 4 to 6 weeks of antibiotics
- Surgery for heart failure, abscess, large vegetations or uncontrolled infection
- Dental care, and teaching about prophylaxis for high-risk patients
Red flags
- New heart failure or acute valve leak
- Stroke signs or a new neurologic deficit
- New heart block on the ECG, which suggests an abscess
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.