Infective Endocarditis Diagnosed by Emergency Physicians Using Cardiac POCUS: A Case Series

Emergency physicians (EPs) are acquiring ever-increasing expertise in cardiac point-of-care ultrasound (POCUS). We compiled this case series to demonstrate current practice by EPs diagnosing infective endocarditis (IE) using POCUS.

This case series outlines 19 cases of IE diagnosed in the Emergency Department (ED) by Australasian EPs. It is a retrospective review of cases occurring between 2013 and 2022.

Our cohort's characteristics: 84% male, with a mean age of 42, and 79% were people who inject drugs (PWID) intravenously. Left heart valves were affected in 68% of patients, with Streptococcus viridans species (37%) and methicillin-sensitive Staphylococcus aureus (MSSA) (53%) being the commonest pathogens identified on blood culture. Mean duration of acute hospitalisation was 30 days, and the mortality rate was 21%.

Echocardiographic diagnosis of IE by EPs is occurring with increasing frequency, and we expect this trend to accelerate further as skillsets and machine image quality improve. Early diagnosis of IE in the ED has high potential to reduce morbidity and mortality in this vulnerable patient group.

Further research is needed to determine the sensitivity and specificity of EP-performed cardiac POCUS for identification of vegetations.