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Infective endocarditis (IE) is an infection of the cardiac endothelium, frequently affecting the valves. It can be classified as either acute vs. subacute, native valve vs. prosthetic valve, or right sided vs. left sided. When there are accumulations at the valves, or leaflet vegetations, they are generally composed of platelet-fibrin thombi, WBCs, and bacteria. ….. Etiology: There are many risk factors for developing IE and they can be placed into different risk categories: High (e.g., prosthetic cardiac valve, previous IE), moderate (e.g., hypertrophic cardiomyopathy, other congenital cardiac defects), low/no risk (e.g., ischemic heart disease, MV prolapse). In addition to these risk factors for IE, running the risk for bacteremia (bacterial infection in circulation) is of particular concern. The following increase the risk for bacteremia with IE: Intravenous drug user (IVDU), indwelling venous catheter, poor dentition, DM, hemodialysis, and HIV. In terms of which valve is infected, it tends to be more common with targeting as follows: MV >> AV > TV > PV. ….. Presentation: 1.Systemic – fever, chills, rigors, weight loss, anorexia, weakness, night sweats 2.Cardiac – dyspnea, chest pain, clubbing, CHF signs, regurgitant murmur 3.Embolic/Vascular – splinter hemorrhages, petechiae, Janeway lesions, H/A (mycotic aneurysm), focal neurological signs (CNS emboli), splenomegaly, flank pain (renal emboli) 4.Immune Complex – Osler’s nodes, arthritis, glomerulonephritis, Roth’s spots ….. Diagnosis: This is done by using the Modified Duke Criteria, which can lead to a diagnosis through various combinations of major and minor criteria. Generally, the criteria relies on blood cultures, evidence of endocardial involvement (e.g., via echocardiogram), new murmurs (auscultation), predisposing conditions, and various symptoms/phenomena. ….. Investigations: Includes blood cultures, CBC, ESR, RF, BUN/Cr, urinalysis, urine C&S, ECG. ….. Treatment: -Empiric