Infectious endocarditis: An update for emergency clinicians

Brit Long, Alex Koyfman
American Journal of Emergency Medicine 2018, 36 (9): 1686-1692

INTRODUCTION: Infectious endocarditis (IE) is a potentially deadly disease without therapy and can cause a wide number of findings and symptoms, often resembling a flu-like illness, which makes diagnosis difficult.

OBJECTIVE: This narrative review evaluates the presentation, evaluation, and management of infective endocarditis in the emergency department, based on the most current literature.

DISCUSSION: IE is due to infection of the endocardial surface, most commonly cardiac valves. Major risk factors include prior endocarditis (the most common risk factor), structural heart damage, IV drug use (IVDU), poor immune function (vasculitis, HIV, diabetes, malignancy), nosocomial (surgical hardware placement, poor surgical technique, hematoma development), and poor oral hygiene, and a wide variety of organisms can cause IE. Patients typically present with flu-like illness. Though fever and murmur occur in the majority of cases, they may not be present at the time of initial presentation. Other findings such as Roth spots, Janeway lesions, Osler nodes, etc. are not common. An important component is consideration of risk factors. A patient with IVDU (past or current use) and fever should trigger consideration of IE. Other keys are multiple sites of infection, poor dentition, and abnormal culture results with atypical organisms. If endocarditis is likely based on history and examination, admission for further evaluation is recommended. Blood cultures and echocardiogram are key diagnostic tests.

CONCLUSIONS: Emergency physicians should consider IE in the patient with flu-like symptoms and risk factors. Appropriate evaluation and management can significantly reduce disease morbidity and mortality.

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