Endocarditis

Injury	Disease	Nutrition	Poison

Symptoms	Surgery	Test	Special Topic

Heart, section through the middle

Heart, front view

Janeway lesion - close-up

Janeway lesion on the finger

Endocarditis

Alternative Names:

Valve infection
Symptoms:

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

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

Signs and tests:

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