- 🔬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: 2–3 blood culture sets + 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.