What are the classic signs of infective endocarditis (IE)?

Updated: Jan 03, 2019
  • Author: John L Brusch, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
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Fever, possibly low-grade and intermittent, is present in 90% of patients.

The AHA (endorsed by the Infectious Diseases Society of America [IDSA]) 2010 guideline update on cardiovascular implantable electronic device (CIED) infections and their management recommends that patients with CIED who develop unexplained fever or bloodstream infection should seek evaluation for CIED infection by cardiologists or infectious disease specialists. [43]

Heart murmurs are heard in approximately 85% of patients. Change in the characteristics of a previously noted murmur occurs in 10% of these patients and increases the likelihood of secondary congestive heart failure.

One or more classic signs of IE are found in as many as 50% of patients. They include the following:

  • Petechiae - Common but nonspecific finding (see the image below)

  • Subungual (splinter) hemorrhages - Dark red linear lesions in the nailbeds

  • Osler nodes - Tender subcutaneous nodules usually found on the distal pads of the digits

  • Janeway lesions - Nontender maculae on the palms and soles

  • Roth spots - Retinal hemorrhages with small, clear centers; rare and observed in only 5% of patients.

    A middle-aged man with a history of intravenous dr A middle-aged man with a history of intravenous drug use who presented with severe myalgias and a petechial rash. He was diagnosed with right-sided staphylococcal endocarditis.

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