Emergency Management

The focus of management in the ED should be on suspecting and diagnosing endocarditis. Patients sometimes present with catastrophic illness relating to acute cardiac failure, severe sepsis, cerebral abscess and stroke or prosthetic valve failure.

Acute treatment for these complications should lead to prompt resuscitation following a structured ABC approach.

Investigations and treatment should be based on the particular complication.

Acute cardiac failure may require diuresis and supported ventilation.

Sepsis should be treated in line with the surviving sepsis campaign guidelines i.e. with a sepsis bundle of care

Some complications, like dehiscence of prosthetic valve, may require urgent surgery as a lifesaving procedure and this should be considered.

The indications for surgery are discussed later in a separate section.