Infection of the endocardium usually lining the heart valves. 

Vegetations comprising of fibrin, platelets and micro-organisms degrade valves.

Aortic valve most commonly affected followed by mitral then tricuspid valves

Fever + new murmur = endocarditis until proven otherwise.

Normal heart valves: Streptococcus Viridans 

Risk factors for normal valves: diabetes, renal failure, immunosuppression

Clubbing, new murmur, splenomegaly, petechiae, Osler’s nodes (painful finger pulp nodules), Janeway lesions (painless palmar lesion), splinter haemorrhages, Roth Spots (retinal haemorrhages), microscopic haematuria, glomerulonephritis.

Bloods: FBC, U&E, LFT, Clotting, CRP

Blood Cultures: 3 sets at different times from different sites

Urine: microscopic haematuria

ECG: Prolonged PR interval or AV node block

ECHO: Assess for vegetations, abscess, congenital lesions and LV function

Diagnosis: Based on Modified Dukes Criteria

Definite – 2 major criteria, 1 major and 3 minor criteria or 5 minor 

criteria

Possible – 1 major and 1 minor criteria or 3 minor criteria

Streptococcus Viridans: 4 weeks IV benzylpenicillin and gentamicin followed 

by 2 weeks of oral penicillin

Staphylococcus Aureus: Flucloxacillin and gentamicin (MSSA) or Vancomycin 

and gentamicin (MRSA) in addition rifampicin is   

required for prosthetic valves for MSSA or MRSA.

Surgical: Prosthetic valve dehiscence, fungal infections, poor antibiotic response

severe heart failure and aortic root abscess with heart block

Septic emboli, acute heart failure, valve regurgitation, septic shock