Infective Endocarditis (IE)

Valve dysfunction and hemodynamics - Acute regurgitation is poorly tolerated; know which valve, the lesion, and ventricular function, and tailor hemodynamic goals to the lesion (acute aortic or mitral regurgitation favors adequate rate and forward flow — avoid bradycardia).

Sepsis physiology - Active infection brings vasodilation, fever, and reduced reserve; support hemodynamics and continue antibiotics.

Embolic risk - Vegetations embolize — septic emboli can cause stroke; document a baseline neuro exam and keep a low threshold for brain imaging, and handle lines and manipulation thoughtfully.

Conduction disease - Perivalvular abscess can cause new heart block; watch the ECG and be ready to pace.

Endocarditis prophylaxis - For at-risk patients undergoing certain procedures, antibiotic prophylaxis is indicated per current criteria; confirm it's addressed.

Progression to valve surgery - Many need urgent valve replacement; coordinate with cardiac anesthesia and surgery.

Infective endocarditis is microbial infection of the endocardial surface, usually a heart valve, producing friable vegetations that destroy the valve, embolize, and seed distant sites.

It causes valvular regurgitation (acute and poorly tolerated), heart failure, conduction disease from perivalvular abscess, septic emboli including stroke, and systemic sepsis. Patients range from indolent subacute disease to fulminant sepsis with collapse; prosthetic valves and IV drug use are major risk factors.