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Internal Medicine
Minor Criteria
Predisposition: predisposing heart condition or IV drug abuse
Fever >38.0 oC.
Embolic phenomena: major arterial emboli, septic pulmonary infarcts, mycotic
aneurysm, intracranial hemorrhage, conjunctival hemorrhages, Janeway lesions
Immunologic phenomena: glomerulonephritis, Osler's nodes, Roth's spots,
rheumatoid factor
Microbiologic evidence: positive blood culture but not meeting major criterion.
Echocardiogram: consistent with infective endocarditis but not meeting major
SOURCE: Adapted from Durack et al.
Definitive Diagnosis can be made by documentation of:
Two major criteria or
One major and three minor criteria or
Five minor criteria allows a clinical diagnosis of definite endocarditis.
All patients should be treated in the hospital to allow adequate monitoring of the development of
complications and the response to the antibiotic therapy.
General measures:
Diet: No special diets are recommended for patients with endocarditis; however, if the
patient has congestive heart failure, sodium-restriction may be necessary.
Activity: Activity limitations are determined by the severity of illness, complications (e.g.,
stroke), and the presence of significant congestive heart failure.
Medical Treatment
The major goals of therapy for infective endocarditis are
Eradicating the infectious agent from the thrombus
Treating the complications of valvular infection
1. Eradicating the infectious agent from the thrombus
Antibiotics remain the mainstay of treatment for IE. In the setting of acute IE,
antibiotic therapy should be instituted as soon as possible to minimize valvular