Endocarditis

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Heart, front view	Heart, section through the middle	Heart valves	Janeway lesion - close-up
Janeway lesion on the finger

Valve infection

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

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

A history of congenital heart disease, rheumatic fever, recent dental work, or intravenous drug use raises the index of suspicion. 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), and petechiae (small, pinpoint hemorrhages) may be detected in the conjunctiva. The fingertips may become enlarged and the nails may curve (clubbing).

Tests:

• repeated blood culture and sensitivity (best test for detection)
• serology for certain bacteria that may be hard to detect by blood culture
• ESR (erythrocyte sedimentation rate)
• CBC may show a high white count and/or low grade, microcytic (small red blood cells) anemia
• ECG
• echocardiogram
• transesophageal echocardiogram
• chest x-ray

Review Date: 02/13/2006
Reviewed By: Monica Gandhi, M.D., M.P.H., Assistant Professor, Division of Infectious Diseases, UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network.