Infective endocarditis (emergency department diagnosis and management)

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Target exams

Red flags

• Blood cultures are taken BEFORE the antibiotics — three sets from three different sites over at least one hour, not a single set from one cannula
• A new regurgitant murmur with a fever is infective endocarditis until proven otherwise
• A Staphylococcus aureus bacteraemia is complicated by infective endocarditis in 10 to 20 per cent of cases — the echo is mandatory even in the apparently uncomplicated case
• Heart failure from the valve destruction is the commonest cause of death and the main indication for the emergency surgery
• A prosthetic valve endocarditis is a surgical disease — the mortality is high and the antibiotic-only approach often fails
• A new atrioventricular block on the ECG in a febrile patient is an aortic-root abscess until proven otherwise — it is a surgical emergency
• Culture-negative endocarditis with a prosthetic valve and a long indolent course suggests Coxiella, Bartonella or a fungus — request the serology early
• A persistently positive blood culture after one week of appropriate antibiotics is uncontrolled infection — call the surgeon