Complexity and subtlety of infective endocarditis.

Infective endocarditis (IE) is an uncommon clinical entity that, if unrecognized, leads to serious morbidity and mortality. Approximately 15,000 new cases of IE occur in the United States each year. Despite advances in early diagnosis, antimicrobial treatment, and surgical techniques, reported mortality from referral centers has changed little throughout several decades. Early recognition of IE requires understanding of its epidemiology, risk factors, clinical presentations, physical examination signs, microbiological associations, and electrocardiographic and chest radiographic findings. Once IE is suspected, further testing with blood cultures and echocardiography can confirm the diagnosis and lead to early treatment with bactericidal antibiotics and surgery when appropriate, thus reducing the morbidity and mortality of IE. Unrecognized and untreated, IE is invariably fatal. Early recognition of IE and an in-depth understanding of the clinical vagaries of IE are mandatory for all patient care providers.