# Cardiovascular infection (endocarditis / myocarditis / pericarditis) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care ## Treatment metadata - No drug therapy in primary care (Referral & Advice) ## Complete treatment card ```text CARDIOVASCULAR INFECTION (ENDOCARDITIS / MYOCARDITIS / PERICARDITIS) 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 Review status: REVIEWED against the source listed above (2026-08) 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 Source StatPearls "Infective Endocarditis" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult 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 Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. 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. Caution 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. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)