[Infectious endocarditis: clinical aspects and diagnosis]

In a discussion of infectious endocarditis (IE), the clinical picture, current most important diagnostic methods (especially echocardiography) and prognosis under conservative therapy and valve replacement are described in detail, in the light of experience at the Hanover Medical School in recent years. While the clinical picture is usually typical, at any rate in the early stages of the disease, antibiotic therapy (when started without blood cultures and exact characterization of the germs involved) or severe complications can change the symptoms to the extent that diagnosis becomes very difficult. Apart from blood cultures, echocardiography, is of prime importance in diagnosis, the latter allows demonstration of vegetations either by M-mode or two-dimensional echocardiography (conventional or esophageal) in some 80% of cases. A special situation is encountered in prosthetic valve endocarditis (PVE): although the incidence of early PVE (which follows hard on the heels of valve replacement) is decreasing, mortality is still high despite early reoperation. Late PVE (after a free interval of approximately 2 months to years) resembles IE of the native valves and often allows medical treatment, especially in the presence of biological valves. The prognosis in IE is still poor and depends mainly on early diagnosis, i.e. a very early start with antibiotic treatment, which must be based on a positive bacterial diagnosis.