General approach to the clinical diagnosis of endocarditis

Infectious endocarditis is a potentially life-threatening disease that remains a challenge to diagnose in a timely fashion. Providers may not initially consider the diagnosis as patients may present with nonspecific clinical signs and symptoms. Despite the presence of a wide array of diagnostic serum studies and imaging modalities, there is no test that can reliably make a diagnosis of infectious endocarditis. Given the potentially devastating consequences of a delayed or missed diagnosis a rule-out approach is warranted in patients with appropriate symptoms, risk factors, typical pathogens, and/or exam, echocardiographic or radiologic findings consistent with endocarditis. A systematic evaluation of patients with suspected endocarditis that utilizes existing literature, current diagnostic testing and criteria, and most importantly well-reasoned clinical judgment is crucial for the diagnosis of the disease.