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Evaluating for IE
- Ask patients about implanted devices, recent procedures, drug use, and unusual exposures.
- Examine for fever, new/worsening murmurs, and less common signs like Janeway lesions.
Workup for Suspected IE
- Obtain blood cultures, echocardiography, and consider a chest CT for septic emboli.
- Check urine protein and microscopy for glomerulonephritis.
TTE vs. TEE
- Transthoracic echo (TTE) sensitivity for IE varies based on pre-test probability, TTE quality, and infection location.
- A normal TTE can rule out IE in low-risk cases, but transesophageal echo (TEE) may still be needed for high risk or prosthetic valves.