Infective endocarditis

Alternative names:

acute endocarditis; bacterial endocarditis; subacute endocarditis

Symptoms:

• fatigue
• weakness
• fever
• chills
• night sweats, may be severe
• weight loss
• muscle aches and pains
• heart murmur
• shortness of breath with activity
• swelling of feet, legs, abdomen
• blood in the urine
• sweating, excessive
• skin spots, red - on the palms and soles, called Janeway lesions
• paleness
• nail abnormalities (splinter hemorrhages under the nails)
• joint pain
• abnormal urine color
• red, painful intradermal nodes in the pads of the fingers and toes called Osler's nodes

Signs and tests:

A history of congenital heart disease raises the index of suspicion. Physical examination may show an enlarged spleen (splenomegaly). The examiner may detect a new heart murmur, or a change in a previous heart murmur. Examination of the nails may show splinter hemorrhages. Eye examination may show retinal hemorrhages with a central area of clearing, called Roth's spots.

Tests:

• Repeated blood culture and sensitivity (#1 test for detection)
• ESR
• CBC may show low grade, microcytic (small red blood cells) anemia
• echocardiogram
• transesophageal echocardiogram
• chest X-ray
• CT scan of the chest
• ASO