Red flags
- Acute HF from valvular destruction
- Embolic events (stroke, splenic, mycotic aneurysm)
- Persistent fever on antibiotics
First steps
- 3 sets blood cultures from different sites over 1 h
- TTE then TOE (higher sensitivity)
- Empirical antibiotics after cultures
Key investigations
- 3 sets blood cultures
- TTE + TOE
- CRP, ESR, CBC, U&E, urinalysis
- Fundoscopy, dental review
Differentials
- Rheumatic fever
- Marantic endocarditis
- SLE valvulitis
Initial management
- Empirical: vancomycin + gentamicin (add rifampicin if prosthetic)
- Native strep viridans: penicillin/amoxicillin 4-6 wk
- Staph aureus: flucloxacillin (vanc if MRSA) 4-6 wk
- Surgery: HF, uncontrolled infection, prosthetic issues, large vegetation with emboli
Referral
- Endocarditis team: cardiology, ID, microbiology, cardiac surgery
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