Furrer H, Malinverni R
Medizinische Universitätsklinik Bern.
Praxis (Bern 1994). 1994 Nov 22;83(47):1309-15.
The first step in the diagnosis of infective endocarditis is a high level of clinical suspicion. Only rarely are all the classic signs of infective endocarditis, namely fever, a new cardiac murmur, splenomegaly, anemia and embolic phenomena, found. Every organ system can be involved by embolic or immunologic complications. We have to look specially for manifestations in skin and mucosa, CNS, kidney, locomotor system and lungs. The clinical spectrum has changed over the last decades. More elderly patients, patients with prosthetic heart valves and i.v. drug users are affected. The traditional classification into acute and subacute infective endocarditis has been replaced by a classification based on the microbiological etiology or on the involved valve (native, prosthetic, left- or right sided). In particular, the clinical presentation of right-sided infective endocarditis differs from the left-sided one. A diagnosis of infective endocarditis has to be considered in every patient with unexplained fever or a multisystem disease. A definite diagnosis of infective endocarditis rests on a multidisciplinary approach that involves the clinician and the echocardiography and microbiology laboratories.
感染性心内膜炎诊断的第一步是要有高度的临床怀疑。感染性心内膜炎的所有典型体征，即发热、新出现的心脏杂音、脾肿大、贫血和栓塞现象，很少会全部出现。每个器官系统都可能受到栓塞或免疫并发症的影响。我们必须特别留意皮肤和黏膜、中枢神经系统、肾脏、运动系统和肺部的表现。在过去几十年中，临床谱已经发生了变化。更多的老年患者、人工心脏瓣膜患者和静脉吸毒者受到影响。传统的急性和亚急性感染性心内膜炎分类已被基于微生物病因或受累瓣膜（天然瓣膜、人工瓣膜、左侧或右侧）的分类所取代。特别是，右侧感染性心内膜炎的临床表现与左侧不同。对于每一位不明原因发热或患有多系统疾病的患者，都必须考虑感染性心内膜炎的诊断。感染性心内膜炎的确切诊断依赖于多学科方法，涉及临床医生以及超声心动图和微生物学实验室。
