Clinical Management and Emergency Approach to Infective Endocarditis

Background / Introduction: Infective endocarditis (IE) is a serious and highly complex cardiovascular condition associated with significant rates of morbidity and mortality, as well as intracardiac and systemic complications. Early, coordinated recognition, thorough microbiological investigation, and timely initiation of treatment in emergency departments are critical for optimizing patient prognosis. Objective: To synthesize recent scientific evidence on the clinical management and emergency approach to IE, addressing multimodal diagnosis, etiological identification, parenteral and oral antibiotic therapy, surgical indications, discharge strategies, and prophylaxis in dentistry. Methods: A narrative literature review conducted in the PubMed database using the MeSH descriptors “Endocarditis, Bacterial” and “Emergency Medicine.” Articles published in the last five years in Portuguese or English were included and underwent thematic screening and comprehensive descriptive-analytical analysis. Results: The primary diagnostic approach involves collecting serial blood cultures prior to initiating antimicrobial therapy and performing transesophageal echocardiography, cardiac CT, or PET/CT. Parenteral antibiotic therapy should cover the main Gram-positive cocci and, in cases of fungal infection, combine broad-spectrum antifungals with urgent surgical debridement. Surgery is indicated in cases of refractory heart failure, uncontrolled infection, and high embolic risk. In selected, stable patients, the transition to oral regimens (as per the POET study) or outpatient parenteral therapy (OPAT) helps reduce the length of hospital stay. Dental antimicrobial prophylaxis is reserved exclusively for high-risk individuals undergoing invasive procedures. Conclusion: Effective management of infectious endocarditis in the emergency department requires a high clinical index of suspicion, an integrated investigation by a multidisciplinary team (Endocarditis Team), and personalized therapeutic approaches to mitigate risks and optimize clinical outcomes.