24th June 2026

Clinical Manifestations

The clinical presentation of IE is extremely variable; it may present with acutely unwell and deteriorating patients, or as a sub-acute condition with non-specific symptoms.

Common signs and symptoms of patients with IE are those of infection:

• fever (seen in approximately 90% of patients)
• chills
• anorexia
• weight loss
• fatigue
• myalgias
• arthralgia
• night sweats
• dyspnoea
• headache
• symptoms related to the cause may also be present, such as toothache

Clinical signs that may be elicited on examination include:

• heart murmurs (seen in 85% of patients with IE)
• splenomegaly
• petechiae
• splinter haemorrhages
• Janeway lesions
• Osler’s nodes
• Roth spots
• heart failure (due to valvular incompetence)
• neurological symptoms (due to septic emboli, intracranial haemorrhage or cerebral abscess)

Image Source: Wikimeadia Commons (2017). January Lesion, Licensed under a creative commons licence. Available for free at: https://commons.wikimedia.org/wiki/File:Janeway_lesion.JPG (Accessed 2 May 2025)

Image Source: Wikimedia Commons (2017). Osler’s Nodes, Licensed under a creative commons licence. Available for free at: https://commons.wikimedia.org/wiki/File:Osler_Nodules_Hand.jpg (Accessed 2 My 2025)

If septic emboli are involved, patients may have signs consistent with renal or splenic infarction, or may have signs consistent with an infective source of the IE (septic arthritis, psoas abscess, osteomyelitis).

In patients presenting with subacute IE, the symptoms may be vague and non-specific, and a high degree of suspicion is required to make the diagnosis. Patients may present with congestive heart failure or a stroke with no other symptoms suggestive of endocarditis.

In patients with a prosthetic valve, whilst the presenting features may be similar to those in patients with NVIE, there are some particular features to be aware of. The frequency of new murmurs, a changing murmur, and presence of conduction defects on an ECG are seen more frequently in patients with IE with a prosthetic valve.