Focused Assessment in Suspected Infective Endocarditis
History- Major symptoms and time course
- Symptoms of systemic embolism (transient ischaemic attack, stroke, abdominal pain, limb ischaemia) or pulmonary embolism (with right-sided valve endocarditis, typically seen with IV drug use)
- Previous endocarditis or other known high-risk cardiac lesion (Table 50.1)
- Antibiotic history (prior antibiotic therapy may render blood cultures negative)
- Dental history (Regular dental surveillance? Dental extraction within 2–6 weeks)
- IV drug use?
Examination- Physiological observations and systematic examination
- Careful examination of the skin, nails, conjunctival and oral mucosae and fundi, looking for stigmata of infective endocarditis (petechiae and splinter haemorrhages). Janeway lesions, Osler nodes and Roth spots are rare.
- Search for alternative source of sepsis, for example inflamed venous cannula site, cellulitis, groin infection in IV drug-use.
- Splenomegaly.
|