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
• red skin spots, located on the palms and soles (called Janeway lesions)
• paleness
• nail abnormalities (splinter hemorrhages under the nails)
• joint pain
• abnormal urine color
• red, painful nodes in the pads of the fingers and toes (called Osler's nodes)

Note: Endocarditis may develop symptoms slowly (subacute) or suddenly (acute).

Signs and tests:

A history of congenital heart disease, intravenous drug use, or chronic localized abscess or infection, 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