Infective endocarditis (IE) is diagnosed by strict criteria – Duke Classification (see next page) – which entail characteristic positive blood cultures and evidence of cardiac involvement. A new cardiac murmur, progressive heart failure, palpitations or pericarditis can all be cardiac manifestations of IE.

Atrioventricular (AV) block may indicate extension of infection into the conducting system (intraventricular septum). Echocardiography should confirm:

  • The presence of vegetations
  • New valve incompetence
  • A cardiac abscess
  • Prosthetic valve dehiscence.

Transthoracic echo is the first choice of investigation but can be inadequate or non diagnostic and a transoesophageal study may be needed.

Patients with haemodynamic compromise should be discussed with the cardiovascular surgeons as a matter of urgency, as immediate surgery may be indicated. However, mortality is high.