The prevention and diagnosis of infective endocarditis. The primary care provider's role

Infective endocarditis, a microbial infection of the endocardium, is a complex multifaceted disease that may affect any organ system. Despite advances in diagnostic technology and treatment, overall mortality rates from infective endocarditis remain between 15-45%, and as high as 40-70% among the elderly. Explanations for the persistence of high mortality rates have focused on delays or errors in diagnosis. The classic diagnostic triad of fever, cardiac murmur, and positive blood cultures are not always present. Elderly patients often have more non-specific symptoms than do younger patients. Infective endocarditis should be considered in conditions dominated by the insidious onset of congestive heart failure, acute mental status or neurological changes, or the acute onset of arthralgias or myalgias. This article reviews the pathogenesis, epidemiology and etiology, risk factors, and clinical presentations of infective endocarditis, as well as current recommendations for antibiotic prophylaxis.