• fatigue
• weakness
• fever
• chills
• night sweats, may be severe
• weight loss
• muscle aches and pains
• heart murmur
• shortness of breath with activity
• swelling of feet, legs, abdomen
• blood in the urine
• sweating, excessive
• red painless skin spots, located on the palms and soles (called Janeway lesions)
• red, painful nodes in the pads of the fingers and toes (called Osler's nodes)
• paleness
• nail abnormalities (splinter hemorrhages under the nails)
• joint pain
• abnormal urine color

Note: Endocarditis may develop symptoms slowly (subacute) or suddenly (acute).

A history of congenital heart disease, rheumatic fever, recent dental work, or intravenous drug use raises the index of suspicion. Physical examination may show an enlarged spleen (splenomegaly).

The examiner may detect a new heart murmur, or a change in a previous heart murmur. Examination of the nails may show splinter hemorrhages.

Eye examination may show retinal hemorrhages with a central area of clearing (called Roth's spots), and petechiae (small pinpoint hemorrhages) may be detected in the conjunctiva. The fingertips may become enlarged and the nails may curve (clubbing).

Tests:

• repeated blood culture and sensitivity (best test for detection)
• serology for certain bacteria that may be hard to detect by blood culture
• ESR (erythrocyte sedimentation rate)
• CBC may show a high white count and/or low grade, microcytic (small red blood cells) anemia
• ECG
• echocardiogram
• transesophageal echocardiogram
• chest X-ray