Key Points

1. Infective endocarditis may be definitely diagnosed from surgical or post mortem material. It may be an unexpected finding, and suspicious pathologic specimens should always be evaluated for microbes.

2. It is useful to consider valve thrombus to be infected until proven otherwise. Multiple special histological stains to look for bacteria and fungi are recommended and complimentary.

3. Gram stain may become negative after antibiotic treatment.

4. Infective endocarditis produces valve destruction usually resulting in valve regurgitation, but rarely stenosis.

5. Very large vegetations are often from culture negative organisms (HACEK) or from fungi.

6. Local perivalvular destructive lesions such as abscesses and fistulas may cause significant complications such as heart failure and arrhythymias. This is a dynamic process and generally progressive, resulting in perivalvular regurgitation, pseudoa-neurysm, or fistula.

7. Prosthetic valve endocarditis may involve both mechanical and bioprosthetic valves. It may be difficult to treat without surgical intervention.

8. Some of the clinical manifestations related to infective endocarditis are due to systemic sequelae including sepsis, embolization, and immune-related complications.

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