Assessment of the Patient With Suspected Endocarditis

IN CONSIDERING the patient with possible infective endocarditis, the medical history and physical examination are of paramount importance, for it is the clinical presentation that usually provides the initial clues to the diagnosis. The majority of cases of infective endocarditis still occur in the setting of underlying rheumatic or congenital heart disease, although the 40% to 60% of cases currently falling into this category are much less than the 80% to 90% of cases seen in earlier years.¹,²A number of other lesions including calcific aortic stenosis and other forms of degenerative heart disease, idiopathic hypertrophic subaortic stenosis (asymmetrical septal hypertrophy), and mitral valve prolapse ("click-murmur" syndrome) may serve as the substrate for infective endocarditis. In recent years, increasing numbers of cases are found superimposed on prosthetic heart valves. Even normal heart valves can become infected, as in acute bacterial endocarditis due toStaphylococcus aureus. Fever is present in