Endocarditis II: Clinical Features of Infective Endocarditis

Infective endocarditis typically begins insidiously, with general symptoms such as fever, chills, weakness, malaise, fatigue, and weight loss.

As the disease progresses, specific vascular signs become apparent. A notable feature is a splinter hemorrhage—black, longitudinal streaks under the nail beds.

Additionally, petechiae, which are small red or purple spots caused by minor hemorrhages, can appear on the conjunctivae, lips, buccal mucosa, palate, ankles, feet, and antecubital and popliteal areas.

Osler's nodes are tender, red or purple, pea-sized lesions found on the fingertips or toes.

Janeway lesions are non-tender, small, erythematous macules found on the palms and soles.

Roth's spots are hemorrhagic retinal lesions with a white or pale center observed during an eye examination.

Cardiac manifestations often include the development of a new heart murmur or changes in an existing one.

Sometimes, murmurs are absent in tricuspid infective endocarditis because right-sided heart sounds are too low to be heard.