Patients may present with clear cardiac manifestations or may be systemically unwell; endocarditis may only be diagnosed after careful investigation including multiple sets of blood cultures. There may be symptoms and signs of infection, cardiac involvement and immune complex deposition as well as signs of septic emboli. Septic emboli may cause focal neurological deficits. The elderly may present with confusion. The classical signs of splinter haemorrhages, Osler’s nodes, Janeway lesions and Roth’s spots are quite rare. Conjunctival or buccal petechial haemorrhages are quite common.

When the diagnosis is suspected, antibiotic treatment should be discussed with local microbiologists prior to starting so that adequate samples are obtained.

Learning bite

If infective endocarditis is suspected, three or four sets of blood cultures should be taken from different sites and they should be taken at least 1 hour apart.