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Clinical features

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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The exact presentation is variable, and will depend upon the type of endocarditis i.e. acute, subacute or prosthetic etc. (1)

The classical diagnostic triad is:

  • persistent fever
  • emboli
  • new or changing murmurs.

Other possible features include:

  • infective - fever - may be low-grade, especially in the elderly, often with rigors; weight loss and anorexia; malaise; night sweats; clubbing after 1-2 months - now rarely seen; splenomegaly; anaemia, usually normocytic, rarely, haemolytic; arthritis
  • cardiac - murmurs; heart failure
  • embolic events - cerebral emboli producing stroke; mycotic aneurysm, potentially causing subarachnoid haemorrhage or affecting the popliteal artery; recurrent pulmonary emboli in right sided endocarditis
  • renal - haematuria from embolism with infarction; mild proteinuria from fever; nephritis usually focal proliferative but may be diffuse
  • vasculitic - splinter haemorrhages; Osler's nodes; Janeway lesions; Roth's spots; vasculitis

1. European Society of Cardiology (Aug 2023). 2023 ESC Guidelines for the management of infective endocarditis.

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