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Clinical features

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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

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

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