Infective Endocarditis
Cardiovascular · ~11% of blueprint- Pathophysiology
- Microbial infection of endocardium/valves → vegetations. S. aureus (acute; IVDU → tricuspid), Strep viridans (subacute, native valve), Enterococcus.
- Signs & Symptoms
- Fever + new murmur. Janeway lesions, Osler nodes, Roth spots, splinter hemorrhages, splenomegaly, embolic phenomena.
- Gold Standard Diagnosis
- 2023 Duke-ISCVID (modified Duke) criteria: ≥3 blood culture sets before antibiotics + echocardiography (TEE more sensitive than TTE).
- First-line Treatment
- Empiric IV vancomycin, then tailor to cultures (gentamicin no longer routine for staphylococcal native valve). Surgery for HF, abscess, or large/embolizing vegetations.
High-Yield Pearl
Draw blood cultures BEFORE antibiotics. IVDU → right-sided (tricuspid) disease with septic pulmonary emboli.
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Sources
Reviewed September 2026- The 2023 Duke-ISCVID Criteria for Infective Endocarditis — ISCVID / Clinical Infectious Diseases, 2023
- Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications (AHA scientific statement) — American Heart Association, 2015
- StatPearls: Infective Endocarditis — NCBI Bookshelf / StatPearls, 2025
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