Summary
Definition
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]
[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].
Chronic IE is not covered in this topic.
History and exam
Key diagnostic factors
- presence of risk factors
- definite IE per diagnostic criteria
- fever/chills
- cardiac murmur
- night sweats, malaise, fatigue, anorexia, weight loss, myalgias
- weakness
- arthralgias
- headache
- shortness of breath
- meningeal signs
- Janeway lesions
- Osler nodes
- Roth spots
Other diagnostic factors
- splinter haemorrhages
- cutaneous infarcts
- chest pain
- back pain
- palatal petechiae
Risk factors
- prior history of infectious endocarditis
- presence of artificial prosthetic heart valves
- certain types of congenital heart disease
- post-organ transplant (patients who develop a cardiac valvulopathy)
- presence of cardiac implanted electronic device or intravascular catheters (e.g., for haemodialysis)
- acquired degenerative valve disease
- mitral valve prolapse (MVP) with valvular regurgitation
- hypertrophic cardiomyopathy
- intravenous drug use
- chronic Q fever
Diagnostic investigations
1st investigations to order
- blood cultures
- echocardiography
- full blood count
- CRP
- serum urea, electrolytes, and glucose
- liver function tests
- urinalysis
- ECG
Investigations to consider
- rheumatoid factor/other immunological blood tests
- erythrocyte sedimentation rate
- complement levels
- computed tomography
- magnetic resonance imaging
- nuclear imaging and photon emission tomography (PET)
Treatment algorithm
Contributors
Expert advisers
Mamta Buch, MBChB, PhD, FRCP
Consultant Interventional Cardiologist
Manchester University NHS Foundation Trust
Manchester
UK
Disclosures
MHB has received speaker honoraria relating to transcatheter heart valve intervention: Medtronic, Edwards. Advisory board relating to transcatheter heart valve intervention: Abbott. MHB is Education Secretary for the British Heart Valve Society and member of the British Cardiovascular Intervention Society Structural Heart working group. MHB has faculty roles at national and international structural heart intervention meetings.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:
Tracey Keteepe-Arachi BSc (Hons), MBBS, MRCP (UK)
Cardiology Specialist Registrar and Clinical Research Fellow
Department of Cardiovascular Sciences
St George's Hospital Medical School
University of London
London
UK
Disclosures: TKA declares that she has no competing interests.
Aneil Malhotra MA (Hons), MSc, MB BChir, MRCP (UK)
Cardiology Specialist Registrar and Clinical Research Fellow
Department of Cardiovascular Sciences
St George's Hospital Medical School
University of London
London
UK
Disclosures: AM is an author of a number of references cited in this topic.
Michael Papadakis MD, MRCP (UK)
Clinical Lecturer in Cardiology
St George's University of London
London
UK
Disclosures: MP declares that he has no competing interests.
Peer reviewers
Bernard Prendergast, BMedSci, BM, BS, MD, FRCP, FESC
Professor of Interventional Cardiology and Valvular Heart Disease
St Thomas' Hospital
London
UK
Disclosures
BP declares that he has no competing interests.
Brian Angus, BSc MBChB, MD, FRCP
Professor
Oxford University
The John Radcliffe
Oxford
UK
Disclosures
BA declares he has no competing interests.
References
Key articles
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
National Institute for Health and Care Excellence. Prophylaxis against infective endocarditis: antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures. July 2016 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available here.
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