Infective Endocarditis Diagnosis and Presentation

Clinical Presentation

Fever is the most common symptom of infective endocarditis, occurring in up to 90% of patients, often accompanied by systemic symptoms such as chills, poor appetite, and weight loss, as recommended by the European Society of Cardiology 1, 2
Heart murmurs are found in up to 85% of patients, according to the European Heart Journal 1
Embolic phenomena are present in up to 25% of patients at diagnosis, as reported by the European Heart Journal 1
Vascular and immunological phenomena, including splinter hemorrhages, Roth spots, and glomerulonephritis, are associated with infective endocarditis, as stated by the European Heart Journal 1

Echocardiography is the cornerstone of diagnosis, with transthoracic echocardiography (TTE) recommended as first-line imaging, and transesophageal echocardiography (TOE/TEE) recommended for patients with high clinical suspicion and normal TTE, as suggested by the European Heart Journal 1, 2, 4
Advanced imaging modalities, such as multi-slice computed tomography (MSCT), magnetic resonance imaging (MRI), and F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT), may be necessary in certain cases, as recommended by the European Heart Journal 1, 2
Definitive diagnosis often requires integration of clinical, microbiological, and imaging findings, as stated by the European Heart Journal 1

Patients with prosthetic valves or intracardiac devices are at high risk for infective endocarditis, as reported by the European Heart Journal 1
Patients with pre-existing valvular or congenital heart disease are also at high risk, according to the European Heart Journal 4

Fever may be absent in elderly patients, after antibiotic pre-treatment, in immunocompromised patients, or in IE involving less virulent organisms, as noted by the European Heart Journal 4
A negative echocardiogram (even TEE) does not rule out IE, particularly in early disease, as stated by the MMWR Recommendations and Reports 5
Early involvement of a multidisciplinary team, including a cardiologist and infectious disease specialist, is highly recommended for suspected cases, as suggested by the European Heart Journal 1