How Is Endocarditis Diagnosed?

A history of congenital heart disease, rheumatic fever, recent dental work, or intravenous drug use raises the index of suspicion. Physical examination may show an enlarged spleen.

The examiner may detect a new heart murmur, or a change in a previous heart murmur. Examination of the nails may show splinter hemorrhages.

Eye examination may show retinal hemorrhages with a central area of clearing (called Roth's spots), and petechiae (small, pinpoint hemorrhages) may be detected in the conjunctiva. The fingertips may become enlarged and the nails may curve (clubbing).

Tests:

• repeated blood culture and sensitivity (best test for detection)
• serology for certain bacteria that may be hard to detect by blood culture
• ESR (erythrocyte sedimentation rate)
• CBC may show a high white count and/or low grade, microcytic (small red blood cells) anemia
• ECG
• echocardiogram
• transesophageal echocardiogram
• chest x-ray