Infectious endocarditis

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Heart, front view

Heart, section through the middle

Infective endocarditis

Janeway lesion on the finger

Endocarditis - infectious

• 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
• Excessive sweating
• Red, painless skin spots on the palms and soles (Janeway lesions)
• Paleness
• Nail abnormalities (splinter hemorrhages under the nails)
• Joint pain
• Abnormal urine color
• Red, painful nodes (Osler's nodes) in the pads of the fingers and toes

A history of congenital heart disease raises the level of suspicion. A physical examination may show an enlarged spleen. 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.

The following tests may be performed:

• Repeated blood culture and sensitivity (#1 test for detection)
• ESR (erythrocyte sedimentation rate)
• CBC (complete blood count) may show low grade, microcytic (small red blood cells) anemia
• Echocardiogram
• Transesophageal echocardiogram
• Chest x-ray
• CT scan of the chest

Review Date: 05/26/2006
Reviewed By: Monica Gandhi MD, MPH, Assistant Professor, Division of Infectious Diseases, UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network.