Endocarditis physical examination

Endocarditis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Infective Endocarditis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications & Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease

Diagnosis and Follow-up

Medical Therapy

Intervention

Case Studies

Case #1

Endocarditis physical examination On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Endocarditis physical examination

CDC onEndocarditis physical examination

Endocarditis physical examination in the news

Blogs on Endocarditis physical examination

to Hospitals Treating Endocarditis physical examination

Risk calculators and risk factors for Endocarditis physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Cafer Zorkun, M.D., Ph.D. [2]

## Overview[edit | edit source]

Common signs on physical examination of endocarditis include fever, presence of a new or changing heart murmur, rigors, Osler's nodes, Janeway lesions and evidence of embolization. Aortic insufficiency with a wide pulse pressure, mitral regurgitation or tricuspid regurgitation may be present depending upon the valve that is infected.

## Physical Examination[edit | edit source]

### Appearance of the Patient[edit | edit source]

* Patients with endocarditis usually appear ill.[1][2]

### Vital Signs[edit | edit source]

* 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[edit | edit source]

* 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

Petechiae |

|

Splinter hemorrhages |
Osler's nodes |
Janeway lesions |

### Oral Cavity[edit | edit source]

Examine the oral cavity:

* Poor oral hygiene

* Teeth looking for periodontitis, plaque and calculus

* Gingiva looking for gingivitis

* Recent dental procedure

### HEENT[edit | edit source]

* Conjunctival hemorrhage
* Roth's spots in the retina
* Bobbing of the uvula may be present among patients with new onset aortic regurgitation.

Roth's spots (white centered hemorrhage)

### Neck[edit | edit source]

* Neck examination of patients with endocarditis is usually normal.

### Lungs[edit | edit source]

* Signs of heart failure such as rales may present

### Heart[edit | edit source]

* Heart murmurs are present in 80% to 85% of patients including that of aortic insufficiency, tricuspid regurgitation and mitral regurgitation.[3]

### Abdomen[edit | edit source]

* 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 pain (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.

### Back[edit | edit source]

* Back examination of patients with endocarditis is usually normal

### Genitourinary[edit | edit source]

* Genitourinary examination of patients with endocarditis is usually normal.

### Neurologic[edit | edit source]

* Septic emboli may result in stroke and focal neurologic findings[4]
* Seizures may be present
* Intracranial hemorrhage may occur
* Signs of a brain abscess may be present

### Extremities[edit | edit source]

* 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)

## References[edit | edit source]

1. ↑ Baddour, LM.; Wilson, WR.; Bayer, AS.; Fowler, VG.; Bolger, AF.; Levison, ME.; Ferrieri, P.; Gerber, MA.; Tani, LY. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145. Unknown parameter `|month=` ignored (help)
2. ↑ Lockhart PB, Brennan MT, Thornhill M, Michalowicz BS, Noll J, Bahrani-Mougeot FK; et al. (2009). "Poor oral hygiene as a risk factor for infective endocarditis-related bacteremia". J Am Dent Assoc. 140 (10): 1238–44. PMC 2770162. PMID 19797553.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link) CS1 maint: PMC format (link)
3. ↑ John MD, Hibberd PL, Karchmer AW, Sleeper LA, Calderwood SB (1998). "Staphylococcus aureus prosthetic valve endocarditis: optimal management and risk factors for death". Clin Infect Dis. 26 (6): 1302–9. doi:10.1086/516378. PMID 9636852.CS1 maint: Multiple names: authors list (link)
4. ↑ John MD, Hibberd PL, Karchmer AW, Sleeper LA, Calderwood SB (1998). "Staphylococcus aureus prosthetic valve endocarditis: optimal management and risk factors for death". Clin Infect Dis. 26 (6): 1302–9. doi:10.1086/516378. PMID 9636852.CS1 maint: Multiple names: authors list (link)

Template:WH Template:WS