Dawaa Reference

chronic

Cardiovascular infection (endocarditis / myocarditis / pericarditis)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class KD01 - condition scope only, no dose · Infective Endocarditis - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK560857/ · No dose - referral pathway, no medicine given in primary care

Verified against1 document
  • No dose - referral pathway, no medicine given in primary care

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (9)

  • Suspect it in anyone at risk who has fever or sepsis with no obvious source [fever · sepsis]
  • Creeping onset of fever, chills, malaise and tiredness, usually bringing the patient in within a month [chills · fatigue · fever · malaise]
  • Temperature above 38 C in more than 95 of every 100 cases [fever]
  • Fever can be missing or muted in the immunosuppressed, the elderly, and after antipyretics or antibiotics [fever]
  • Poor appetite, headache and general weakness are common [headache · poor appetite]
  • Chest pain, breathlessness, poor exercise tolerance, orthopnoea or night attacks point to a damaged valve [breathlessness · chest pain · orthopnoea]
  • A valve that fails suddenly presents as abrupt heart failure with unstable circulation
  • Ask about lines, injected drugs, rheumatic heart disease, a recent pacemaker, prosthetic valves and congenital defects
  • Worn valves such as calcified aortic stenosis or mitral prolapse lie behind roughly 30 in 100 cases [stricture]

Signs — what you find (9)

  • Fever is usual; fast breathing and fast pulse may go with it [fever · tachypnoea]
  • Low blood pressure from septic or cardiogenic shock, above all when a valve has perforated [hypotension · sepsis · shock]
  • A new or louder murmur is found in fewer than half, but it locates the affected valve [heart murmur]
  • Crackles in both lung bases with severe mitral or aortic regurgitation [crackles]
  • Osler nodes: tender red lumps under the skin of palm, fingers and toes
  • Janeway lesions: painless bleeding-looking patches on palms and soles, plus splinter haemorrhages [bleeding]
  • Each of these skin signs appears in fewer than one patient in ten
  • An enlarged spleen, or peritonitis from gut ischaemia [ischaemia · splenomegaly]
  • Focal weakness, numbness or visual change points to clot thrown to the brain [numbness]

Tests (12)

  • Blood count often shows a high white count; longer-standing cases show anaemia of chronic disease
  • ESR and CRP are raised in about 60 of every 100 cases, but prove nothing on their own
  • Urine may show protein, unseen blood or pus cells from kidney injury or infarction
  • Diagnosis rests on the germ grown and what the echo shows
  • Two separate cultures positive for viridans streptococci, S gallolyticus, HACEK, S aureus or community enterococci with no other source
  • For unusual germs, bacteraemia must persist: two cultures over 12 hours apart, or most of at least four
  • Echo evidence means a mobile mass on a valve, its supports, or prosthetic material
  • Lung disease, past chest surgery, obesity and prosthetic valves blur the transthoracic view, so go early to transoesophageal
  • Cardiac CT beats transoesophageal echo for an abscess beside the valve, 88 against 74 in 100
  • ECG is often normal, but ST elevation is treated as a myocardial infarction whatever else is going on
  • Chest film may show lung shadowing, abscess or fluid, and with a leaking left-sided valve, oedema and a big heart
  • New focal neurological signs need urgent brain imaging and a neurology opinion

If not this — what else fits (6)

  • With chest pain: aortic dissection, myopericarditis, acute heart failure or acute coronary syndrome
  • Also lung clot, pneumonia or empyema
  • With a prosthetic valve: clot around the valve, especially if anticoagulation lapsed, or sutures giving way
  • Repeated arterial emboli soon after a heart attack suggest clot lining the ventricle
  • A new murmur in a well young adult raises atrial myxoma
  • Sterile valve clot: marantic endocarditis with cancer, or Libman-Sacks with lupus

SourceStatPearls "Infective Endocarditis" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)

1st line
Adult dose and duration

Covers endocarditis, myocarditis, and pericarditis, all of which need urgent hospital referral for cultures, imaging, and intravenous therapy; the GP's role is recognition and same-day referral, with simple analgesia for pericarditic chest pain while arranging transfer. - Refer, with advice

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

Covers endocarditis, myocarditis, and pericarditis, all of which need urgent hospital referral for cultures, imaging, and intravenous therapy; the GP's role is recognition and same-day referral, with simple analgesia for pericarditic chest pain while arranging transfer.

Cautions
  • Fever with a new heart murmur, breathlessness, chest pain, or embolic signs (stroke, painful fingers or toes) must be treated as a medical emergency.
  • No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.