Dyspnea

• Myalgia or arthralgias Signs

• Fever is the most common sign of IE

• New or changing heart murmur

• Embolic phenomena (emboli affect the heart, lungs, abdomen, or extremities)

• Skin manifestations (e.g., petechiae, splinter hemorrhages, Osler's nodes, Janeway's lesions)

• Splenomegaly

• Clubbing of extremities Laboratory Tests

• Blood cultures are the most important laboratory assessment for persistent bacteremia, which occurs commonly in IE. A minimum of three blood culture sets should be collected during the initial 24 hours

• Hematologic tests for anemia (normochromic, normocytic)

• WBC count may be elevated in acute disease but could be normal in subacute IE

• Nonspecific findings such as thrombocytopenia, elevated erythrocyte sedimentation rate or C-reactive protein, and abnormal urinalysis (i.e., proteinuria or microscopic hematuria)

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