Management

The patient should be referred because optimal management requires close co-operation between physician, microbiologist and cardiac surgeon.

General symptoms

• intermittent fever"

? palior r?f anaemia thoracic back pa:n (pulmonary ' infarction)

abdomirül pain arthritis

T common features

General symptoms

• intermittent fever"

? palior r?f anaemia

T common features

neurological problems cerebri emboli retinal haemorrhages (Roth's Spots)

cardiac murmurs cardiac failure

Fig. 26.2 Infective endocarditis: possible clinical features neurological problems cerebri emboli retinal haemorrhages (Roth's Spots)

mucosal petecnise cardiac murmurs cardiac failure splenomegaly* (silgnt:

nar<t signs

Janewayr lesion^ ones's ncdes splinter- h3em-3r-i haae& ? clubbing

Urinalysis blood {microscopio* protei nuda

Fig. 26.2 Infective endocarditis: possible clinical features

Any underlying infection should be treated, e.g. drainage of dental abscess. Bactericidal antibiotics are chosen on the basis of the results of the blood culture and antibiotic sensitivities. Four blood cultures should be sent to the laboratory within the first hour of admission and treatment should seldom be delayed longer than 24 hours.

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