Endocarditis signs and physical examination


 * Associate Editors-in-Chief:

Vital Signs

 * A fever will likely be present.
 * Rigors may be present.
 * Some patients may have a wide pulse pressure due to aortic insufficiency. If the pulse pressure narrows, this may be a sign of left ventricular failure due to earlier closure of the mitral valve and a more rapid rise in the left ventricular end diastolic pressure which will in turn raise the diastolic pressure.

Skin

 * Petechiae are present in 10% to 40% of patients
 * Splinter hemorrhages are present in 5% to 15% of patients
 * Osler's nodes which are tender subcutaneous nodules in pulp of digits are present in 7% to 10% of patients
 * Janeway lesions which are erythematous, nontender lesions on palm or sole are present in 6% to 10% of patients

Eyes

 * Conjunctival hemorrhage
 * Roth's spots in the retina

Ear Nose and Throat
In patients in whom there is new acute onset of aortic regurgitation, bobbing of the uvula may be present.

Heart

 * Heart Murmur(s) are present in 80% to 85% of patients including that of aortic insufficiency, tricuspid regurgitation and mitral regurgitation.

Lungs

 * Signs of heart failure such as rales may present

Abdomen

 * Abdominal pain may be present due to mesenteric embolization or ileus both of which may manifest as reduced bowel sounds
 * Splenomegaly may be present in 15% to 30% patients.
 * Left upper quadrant (LUQ) pain may be present as a result of a splenic infarct from embolization.
 * Flank pain may be present as a result of an embolus to the kidney

Extremities

 * Janeway lesions (painless hemorrhagic cutaneous lesions on the palms and soles)
 * Gangrene of fingers may occur
 * The fingers may show splinter haemorrhages
 * Osler's nodes (painful subcutaneous lesions in the distal fingers)

Neurologic

 * Septic emboli may result in stroke and focal neurologic findings
 * Seizures may be present
 * Intracranial hemorrhage may occur
 * Signs of a brain abscess may be present