Cardiology is the medical specialty focused on the heart and the cardiovascular system. It involves the diagnosis, treatment, and prevention of conditions affecting the heart and blood vessels. These conditions include coronary artery disease, heart failure, arrhythmias (irregular heartbeats), and valve disorders. The field covers a broad spectrum, from congenital heart defects present at birth to acquired conditions like heart attacks.
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Diagnosing endocarditis is a puzzle. Doctors rarely rely on a single test to confirm it. Instead, they use a set of strict clinical criteria known as the Duke Criteria. This system combines physical evidence, lab results, and imaging to reach a definitive diagnosis. Because the consequences of missing the diagnosis are so severe, doctors tend to be very thorough if they even slightly suspect a heart infection.
The diagnostic process usually happens in a hospital setting. It moves quickly from basic blood work to advanced heart imaging. The aim is to confirm an infection, identify the bug, and assess the damage to the heart. This precision is vital for choosing the right antibiotic and deciding if surgery is needed.
Blood cultures are the most critical diagnostic test. Before starting any antibiotics, doctors will draw blood from several different veins in your arms. Usually, they take three or more sets of samples over a period of 24 hours. These samples are sent to a lab to see if bacteria grow.
Finding the specific bacteria is crucial. Different germs require different antibiotics. For example, a staph infection needs an entirely different drug than a strep infection. Taking multiple samples helps ensure that a positive result is real and not just contamination from the skin. It also helps detect if the bacteria are constantly released into the blood, which is a hallmark of endocarditis.
An echocardiogram, or “echo,” is an ultrasound of the heart. It uses sound waves to create moving pictures of the heart’s valves and chambers. This type of imaging is the primary way doctors see the infection. They are looking for vegetations—the clumps of bacteria and cells stuck to the valves. They also look for abscesses (pockets of infection) or leaks in the valves caused by tissue damage.
There are two main types of echocardiograms used. An echocardiogram (TTE) is the standard test where a probe is placed on the chest. It is non-invasive and painless. However, if the TTE doesn’t show a clear picture (which can happen in about 30% of cases), doctors will move to a transesophageal echo (TEE).
In a TEE, a flexible tube with a probe is guided down the throat into the esophagus. Because the esophagus sits right behind the heart, the procedure provides incredibly clear, detailed images without the ribs or lungs getting in the way. It is the gold standard for finding small vegetation or complications, like abscesses.
This is the first step. It is useful for visualizing the heart’s size and assessing how well it is pumping. However, it might miss smaller details, especially in patients with artificial valves or obesity.
Doctors use a checklist called the Modified Duke Criteria to make a formal diagnosis. This list divides evidence into “Major” and “Minor” categories. To diagnose endocarditis definitively, a patient usually needs two major criteria, one major and three minor, or five minor criteria.
Major criteria include positive blood cultures with typical endocarditis bacteria and evidence of heart involvement on an echo (like vegetation). Minor criteria include vascular phenomena like emboli or hemorrhages. This system helps doctors avoid misdiagnosis, ensuring they don’t treat a simple virus as a heart infection or miss a true heart infection because symptoms are vague.
Sometimes, the diagnosis is still not clear, or doctors suspect the infection has spread beyond the heart. In these cases, a CT scan or MRI might be used. A CT scan of the chest can help identify abscesses around the heart valves that an echo might miss.
Doctors might also scan other parts of the body. A CT scan of the abdomen or an MRI of the brain can detect if pieces of the infection (emboli) have broken off and traveled to the spleen, kidneys, or brain. Finding these distant spots of infection supports the diagnosis of endocarditis and helps doctors understand the full extent of the disease.
An electrocardiogram (ECG or EKG) records the electrical activity of the heart. While it cannot “see” the bacteria, it can show the damage they are doing. If an infection burrows into the heart tissue near the electrical pathways, it can cause a “heart block,” where the signal is delayed or stopped.
A new heart block on an ECG in a patient with fever is a worrisome sign. It suggests an abscess has formed and is invading the heart muscle. The condition is a serious complication that often requires surgery. Therefore, regular ECGs are part of the monitoring process for endocarditis patients.
Routine blood tests provide supporting evidence. A Complete Blood Count (CBC) often shows anemia (low red blood cell count), which is very common in subacute endocarditis. It also typically shows a high white blood cell count, indicating an active infection.
Markers of inflammation, such as C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR), are almost always elevated. While these tests are not specific—they go up for many infections—they help build the case. If these numbers are normal, endocarditis is much less likely. They are also useful for tracking recovery; as the antibiotics work, these numbers should drop back to normal.
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Not necessarily. While most cases have positive cultures, about 5%–10% are “culture-negative.” This can happen if you took antibiotics before the blood draw or if the infection is caused by a fastidious (hard-to-grow) organism. Doctors use other tests to find these hidden germs.
It is uncomfortable but generally not painful. You are given medication to sedate you and numb your throat. Most patients do not remember the procedure. It is a quick but essential test for getting a clear view of the valves.
It depends. If blood cultures grow bacteria quickly (within 24 hours) and the echo shows vegetation, diagnosis is fast. It can take days or even weeks of testing in subacute cases with vague symptoms to fully understand the condition.
The infection can spread silently. A CT scan checks if clumps of bacteria have flown off the heart valve and landed in organs like the spleen, liver, or brain. Finding these distant infections changes how aggressive the treatment needs to be.
A vegetation is a mix of bacteria, inflammatory cells, and clot material. A simple clot is just blood cells. On an echo, they can look similar, but their movement and the patient’s symptoms (like fever) help doctors tell them apart.
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