Warning signs for development of endocarditis

• change in character of heart murmur

• development of a new murmur

• unexplained fever and cardiac murmur = infective endocarditis (until proved otherwise)

• a febrile illness developing after instrumentation (e.g. urethral dilatation) or minor and major surgical procedures, e.g. dental extraction, tonsillectomy, abortion

• the 'classic tetrad' of clinical features 4

o signs of infection o signs of heart disease o signs of embolism o immunological phenomena

There is a significant high mortality and morbidity from infective endocarditis which is often related to a delay in diagnosis.

A golden rule

Culture the blood of every patient who has a fever and a heart murmur.

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