Clinical presentation of subacute infective endocarditis
THE CONTEXT
Infective endocarditis may present acutely or develop insidiously. Subacute disease can initially go unrecognised and later cause sudden serious complications.
Clinical course
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Acute and subacute presentations overlap because the clinical pattern depends on the organism, infection site, prior antibiotic therapy and presence of a valve or shunt prosthesis.
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Subacute endocarditis can abruptly develop life-threatening complications, including valve disruption or emboli.
When to suspect subacute endocarditis
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Suspect subacute endocarditis in a patient with congenital or valvular heart disease who develops persistent fever, unusual tiredness, night sweats or weight loss.
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New signs of valve dysfunction or heart failure are additional reasons for suspicion.
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Less commonly, the presentation is an embolic stroke or peripheral arterial embolism. Purpura may also occur.