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.